How should Uremol HC (hydrocortisone) be used in a patient with eczema or dermatitis?

How to Use Uremol HC (Hydrocortisone) for Eczema or Dermatitis

Apply Uremol HC (hydrocortisone 1% with urea 10%) twice daily to affected areas as a first-line treatment for mild-to-moderate eczema, using it for 2-3 weeks maximum before reassessing, then implement treatment breaks ("steroid holidays") to minimize side effects. 1

Application Frequency and Duration

• Apply no more than twice daily to affected skin areas—once daily application is equally effective for potent corticosteroids, but hydrocortisone 1% (a mild corticosteroid) is typically used twice daily 1, 2
• Limit continuous use to 2-3 weeks, then reassess the patient's condition and implement short breaks when the eczema is controlled 1
• The combination of hydrocortisone 1% with urea 10% provides effective treatment without the side effects seen with stronger corticosteroids, making it suitable for longer-term intermittent use 3

Specific Application Instructions

• Apply to dry skin unless otherwise specified—ointment formulations work best on dry, lichenified eczema 1
• Use on the face and neck with confidence, as hydrocortisone 1% is classified as a mild corticosteroid appropriate for thin-skinned areas 1, 4
• Avoid very potent or potent corticosteroids on the face; hydrocortisone 1% is the correct potency for facial application 4

Quantity to Prescribe

For twice-daily application over 2 weeks, prescribe approximately: 1

• Face and neck: 15-30 g
• Both hands: 15-30 g
• Both arms: 30-60 g
• Both legs: 100 g
• Trunk: 100 g

Essential Concurrent Measures

• Prescribe liberal amounts of emollients (200-400 g per week for twice-daily whole-body application) to be used continuously, even when eczema appears controlled 1, 5
• Instruct patients to apply emollients after bathing to provide a surface lipid film that prevents water loss 5, 4
• Recommend soap-free cleansers and avoidance of alcohol-containing products, which dehydrate the skin 1, 5

Managing Treatment Response

If the eczema improves within 2 weeks: 1

• Implement a "steroid holiday" by stopping the hydrocortisone temporarily
• Continue emollients throughout
• Resume hydrocortisone if flare-ups occur

If there is no improvement after 2 weeks: 1

• Consider stepping up to moderate-potency corticosteroids (e.g., clobetasone butyrate 0.05%) for the body
• Keep hydrocortisone 1% for facial areas
• Reassess for secondary bacterial infection

Recognizing and Managing Secondary Infection

Watch for these signs indicating bacterial superinfection: 5, 4

• Increased crusting, weeping, or pustules
• Sudden worsening despite treatment

When infection is present: 5, 4

• Continue the hydrocortisone—do not stop topical corticosteroids when appropriate systemic antibiotics are given concurrently
• Prescribe oral flucloxacillin as first-line for Staphylococcus aureus (the most common pathogen) 1, 5
• Use erythromycin if penicillin allergy exists 1

If you observe grouped vesicles, punched-out erosions, or sudden deterioration with fever: 5, 4

• Suspect eczema herpeticum (a medical emergency)
• Initiate oral acyclovir immediately
• Give intravenously if the patient is ill or febrile 1, 5

Critical Pitfalls to Avoid

• Do not delay topical corticosteroids when infection is present—they remain the primary treatment when appropriate systemic antibiotics are given 5, 4
• Do not use continuous corticosteroid therapy without breaks—implement "steroid holidays" when disease is controlled to minimize pituitary-adrenal suppression risk 1, 5, 4
• Do not prescribe non-sedating antihistamines—they have little to no value in atopic eczema 1, 5
• Address patient fears about corticosteroids—explain that hydrocortisone 1% is the mildest potency and appropriate for long-term intermittent use when combined with treatment breaks 5

When to Escalate or Refer

Refer to dermatology if: 5

• Failure to respond to hydrocortisone after 4 weeks of appropriate use
• Need for potent or very potent corticosteroids beyond short-term use
• Suspected eczema herpeticum (urgent referral)

FDA-Approved Indications

Hydrocortisone topical is FDA-approved to temporarily relieve itching associated with minor skin irritations, inflammation, and rashes due to eczema, as well as other dermatoses 6