Hydrocortisone

What is the science behind hydrocortisone steroid creams?

Hydrocortisone is classed a corticosteroid. This class of molecules can reduce inflammation, redness, itching & swelling. Used appropriately they can reduce pimples, zits, cysts, along with other inflammatory skin conditions including eczema, psoriasis, dermatitis, allergies, sunburn, as well as stings & insect bites.

Is steroid cream bad for you?

Long term use of steroids can lead to side effects. Be guided by your medical dermatologist.  Used in short bursts or application cycles, steroids have a good safety record. Dermatologists employ these medications in a pulsed or rotational manner.  An example is to use topical steroids nightly for one week, giving a break for the following week.

Are steroids useful in the treatment of acne - zits?

Yes, a quick precise shot of emergency cortisone can kill that zit or cyst. Steroid injections are best, however if you have an important event to attend, try some cortisone cream or ointment. Steroids work best on inflammatory pimples & pustules. Try three times a day application with 1% HC cream. Limit to 7 day maximum. See a healthcare professional if no better.

Disclaimer: I am a procedural and not a medical dermatologist. I do not treat acne however my colleagues @cliniccutis can assist.

How do I use hydrocortisone?

OTC preparations in Australia include 0.5 & 1% formulations. Ointments are better than creams unless the lesion in question is weeping (like a popped pimple). If that’s the case, a cream will be fine. Apply 2-3 times a day to dry skin (after a dab with a cotton pad). Apply a super thick layer at night. You can ‘supercharge’ the application by occluding with a hydrocolloid patch. Note- if you do take this approach, hydrocortisone will be much more effective- limit application to 4 to 5 days maximum.

Hydrocortisone can also be used to treat chronic skin conditions such as psoriasis, eczema & seborrheic dermatitis.

How long does it take hydrocortisone to work?

For pimples & zits, hydrocortisone can start to work within 12 to 36 hours.  For rashes, bites & eczema, it may take 2-4 days to see the effect of steroid preparations.

How long can I use hydrocortisone for?

Most dermatologists would say a maximum of 10-14 days would be safe, after which you should go on rotational therapy. This means for every day you use a steroid, you should have an off day. For example if you use hydrocortisone for 7 straight days, you should give 7 days break before restarting. Be guided by your skin care professional.

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What are the side effects of hydrocortisone?

Like any medication, sensible use will reduce side effects. These include-

• Thinning of skin
• Steroid induced acne
• Perioral dermatitis
• Stretchmarks
• Tachyphylaxis

What is steroid induced acne / perioral dermatitis?

This is a common condition secondary to steroid use, most often seen with stronger steroids such as Elocon, Betnovate, Desowen, however it can occur with weaker steroids including hydrocortisone.

This rash presents as tiny bumps known as papules (acne like lesions) around the mouth, nose & eye area. The classic history is one of improvement with steroid preparations, but rebound or worsening once the steroid is stopped. This is akin to ‘steroid addiction.’ Fortunately the vast majority of perioral dermatitis can be treated with really basic skin care, avoidance of topical steroids & a short course of anti-inflammatory abs such as doxycycline,minocycline or erythromycin.  Be guided by your skin care professional.

Disclaimer: I am a procedural dermatologist, conditions like perioral dermatitis & rashes are managed by my medical colleagues.

What are other steroid free anti-inflammatories?

There are many steroid free preparations that dermatologists employ to manage skin conditions, examples include:

Pimecrolimus: Also known as Elidel, this is a calcineurin inhibitor.

Tacrolimus: Or Protopic is also a calcineurin inhibitor.

Azelaic Acid: Is a naturally occurring anti-inflammatory found in wheat, barley & rye.

Doxycycline: Is a powerful anti inflammatory

Erythromycin: Can be used in pregnancy, it has anti-inflammatory effects.

Be guided by your medical dermatologist as to the correct combination for your skin.

Davin’s Pro Tip On the use of Hydrocortisone

This basic steroid is an emergency fix for many skin conditions, much akin to the use of WD40 or duct tape for household chores! Steroids are super handy for extinguishing fires from irritant contact dermatitis to cosmetics, over application of actives, dermatitis, eczema, sunburn & even pimples.  Keep application times short and sharp & most people will not run into trouble.