Hydrocortisone Dosing for Contact Dermatitis
For an adult with contact dermatitis, apply hydrocortisone 2.5% cream or ointment twice daily to affected areas, or use moderate-to-high potency topical corticosteroids (such as triamcinolone 0.1% or betamethasone valerate 0.1%) twice daily for localized lesions. 1, 2
Topical Corticosteroid Selection by Severity
Mild to Moderate Contact Dermatitis:
- Apply hydrocortisone 2.5% cream twice daily to affected areas 1
- Alternatively, use moderate-to-high potency steroids such as mometasone furoate 0.1% ointment or betamethasone valerate 0.1% ointment twice daily 1
- For localized acute allergic contact dermatitis, mid- or high-potency topical steroids like triamcinolone 0.1% or clobetasol 0.05% are effective 2
- Continue treatment for up to 4 weeks under physician supervision 3
Severe or Extensive Contact Dermatitis (>20% body surface area):
- Initiate systemic corticosteroids immediately with prednisone 0.5-1 mg/kg body weight for 7 days 1
- Follow with a weaning dose over 4-6 weeks to prevent rebound dermatitis 1, 2
- Continue topical corticosteroids to affected areas concurrently 1
- Critical pitfall: Ensure the taper is long enough (4-6 weeks minimum) as rapid discontinuation causes rebound flare 1, 2
Adjunctive Symptomatic Management
For pruritus control:
- Add oral antihistamines: loratadine 10 mg daily during daytime (non-sedating) 1
- At night, use first-generation antihistamines: diphenhydramine 25-50 mg or hydroxyzine 25-50 mg for sedative properties 1, 4
- If antihistamines fail, consider GABA agonists as second-line: pregabalin 25-150 mg daily or gabapentin 900-3600 mg daily 1
Supportive care measures:
- Apply alcohol-free moisturizing creams or ointments twice daily, preferably with 5-10% urea 1
- Use cool compresses for symptomatic relief 1
- Avoid hot water washing and skin irritants including over-the-counter anti-acne medications 1
Important Clinical Caveats
Over-the-counter hydrocortisone (typically 0.5-1%) has not been shown to improve symptoms in randomized trials 1, which is why prescription-strength preparations (2.5% or higher potency alternatives) are necessary for effective treatment.
Watch for secondary bacterial infection: Check for increased warmth, tenderness, purulent drainage, honey-colored crusting, or cellulitis, which require antibiotic therapy 1
Duration considerations: Treatment beyond 12 weeks can be considered only under careful physician supervision 3. Gradual reduction in frequency after clinical improvement is recommended to avoid rebound 3.
Contraindications to be aware: Corticosteroid hypersensitivity occurs in 2-5% of contact dermatitis clinic patients, most frequently in those with stasis dermatitis 5, 6. If treatment fails despite appropriate therapy, consider patch testing to rule out corticosteroid allergy 2, 6.