Application Order of Hydrocortisone and Barrier Cream for Dermatitis
Topical corticosteroids (hydrocortisone) should be applied BEFORE barrier creams for optimal effectiveness in treating skin conditions like dermatitis.
Rationale for Applying Hydrocortisone First
- Topical corticosteroids are the mainstay of treatment for dermatitis and need direct contact with the skin to exert their anti-inflammatory effects 1
- Applying hydrocortisone first ensures maximum absorption into the skin where it can effectively reduce inflammation 1
- Barrier creams applied first would create a physical barrier that could impede the penetration of the active medication (hydrocortisone) into the skin 1
Proper Application Technique
- Clean and gently dry the affected area before applying any treatments 1
- Apply a thin layer of hydrocortisone cream to the affected area 1
- Allow the hydrocortisone to absorb for a few minutes 1
- Then apply the barrier cream/moisturizer to help restore the skin barrier function 1
- For hand dermatitis specifically, apply moisturizer after washing hands and before wearing gloves 1
Evidence on Absorption and Efficacy
- Studies show that hydrocortisone absorption is significantly higher during acute phases of dermatitis compared to remission phases, indicating the importance of direct skin contact 2, 3
- The effectiveness of topical steroids can be compromised if they cannot penetrate the skin adequately 1
- Barrier creams and regular moisturizing lotions help replenish skin barrier integrity and function after the medication has been absorbed 1
Special Considerations
- Use the least potent corticosteroid preparation required to keep the dermatitis under control 1
- Limit application to twice daily maximum; some newer preparations require only once daily application 1
- For nighttime treatment, apply moisturizer after the medication and consider occlusion with cotton or loose plastic gloves to enhance effectiveness 1
- Water-based moisturizers are safe under all gloves; oil-based moisturizers can break down latex and rubber 1
Potential Pitfalls to Avoid
- Avoid applying greasy topical products before radiation treatment (if applicable) as they can cause a bolus effect, artificially increasing radiation dose to the epidermis 1
- Be aware that even mild potency corticosteroids like 1% hydrocortisone can cause transient epidermal thinning after just 2 weeks of treatment 4
- Topical steroids should not be applied more than twice daily as more frequent application does not improve efficacy but increases risk of side effects 1
- Avoid using topical steroids under occlusion without underlying moisturizer application, as this increases risk of adverse effects 1
By applying hydrocortisone first and barrier cream second, you optimize the therapeutic effect while maintaining skin barrier protection.