Hydrocortisone for Eczema Treatment - Health Central
In our fast paced, ever-changing world, there are only a few things that stand the test of time. Hydrocortisone is one of those things. First used for the treatment of eczema and other skin conditions in the 1950s, the tried-and-true anti-inflammatory and anti-itch properties of hydrocortisone have made it one of the most widely prescribed topicals for eczema.
"Topical steroids are first-line—and necessary—in the management of eczema," says Karan Lal, D.O., director of pediatric dermatology and cosmetic surgery at Affiliated Dermatology in Scottsdale, AZ. But what makes hydrocortisone so different from any other topical cream? And does it work for everyone? We asked dermatologists to explain the hype. Here's what they shared.
How Is Hydrocortisone Used to Treat Eczema?
From the class of meds called corticosteroids, hydrocortisone comes in ointment, cream, lotion, liquid, and spray form (so pick your favorite formula) and can relieve the troublesome itch, swelling, and overall discomfort that's an inevitable part of an eczema flare-up.
Corticosteroids work by suppressing multiple inflammatory genes that are activated in eczema (and other chronic, inflammatory skin conditions). Topical hydrocortisone is not a systemic medication—meaning it does not target the root of eczema—but rather, it addresses surface symptoms of the disease. As a treatment for eczema, hydrocortisone reduces inflammation, which in turn eases symptoms like itchiness. It's available over the counter and in stronger forms by prescription.
How Much Hydrocortisone Do I Need to Apply?
New York City-based dermatologist Radha Mikkilineni, M.D., who is also a clinical assistant professor of dermatology at Weill Medical College of Cornell University in New York City, agrees that "nothing works better than hydrocortisone for an eczema flare." However, she points out that the correct strength—from 0.1% (1mg of hydrocortisone in each gram) to 2.5% (25mg of hydrocortisone in each gram)—varies by location on the body and severity of the flare.
If you're new to the eczema game, it's easy to be confused by those numbers. Top tip: bigger doesn't necessarily mean stronger. In fact, the labelled percentage of steroid doesn't relate to the potency. For instance, clobetasol (Temovate) 0.05% is very potent, while hydrocortisone 2.5% has mild potency. So always ask your doctor or pharmacist if you need clarification.
Dr. Mikkilineni typically prescribes hydrocortisone 2.5% for adults who have eczema on their face or neck (because the skin is more sensitive here than on other parts of the body). "Medium to high potency [corticosteroids] can be used for eczema on the trunk, arms, and hands," she adds. Dr. Mikkilineni points out that there are other topical steroid options besides hydrocortisone that your doc may recommend for you, such as triamcinolone (Kenalog or Aristocort) 0.1%, or even clobetasol (Temovate) 0.05% for very thick long-standing lesions and eczema patches on the hands and feet.
How to Apply Hydrocortisone for Eczema
You should always follow your doctor's instructions for applying topical hydrocortisone (or refer to the directions on the packaging if you buy it OTC). Generally, it's advised to use topical hydrocortisone two times a day to the affected areas until the eczema goes away, before slowly tapering to using it two or three times a week to "hot spots" (a.k.a. your most troublesome areas), for up to three months.
The general instructions for hydrocortisone use are the same for adults and children:
Wash and dry your hands before use.
Apply a thin layer of the topical to any irritated areas.
Gently rub it in until it's completely disappeared into your skin.
Wash and dry your hands when you've finished applying.
Wait at least 10 minutes before applying any other skin care products to let the hydrocortisone fully absorb.
It's important to not get hydrocortisone in open cuts or sores, and to keep it away from your eyes, adds Dr. Lal. If you get steroids in your eyes it puts you at risk for developing cataracts in later life, so be careful when applying around the eye area.
Can Hydrocortisone Be Used for Eczema Rash on Babies?
Per the National Eczema Association, eczema often first appears in the first few years of a child's life, and symptoms can occur as early as six months. So, is it safe to use hydrocortisone cream for eczema on babies? Absolutely, says Dr. Lal: "Hydrocortisone cream 1% (available over the counter as well as on prescription) is safe for all ages."
Some doctors may advise you to use a low potency topical hydrocortisone on your infant for only a short period of time, but Dr. Lal takes a different approach. He believes that you should never use a topical steroid for only a few days then stop if you're using it to treat a chronic condition like eczema: "You need maintenance."
Dr. Lal typically prescribes 2.5% hydrocortisone ointment for mild to moderate eczema in babies, on both the face and body. "It truly works when used appropriately." He recommends using it twice a day until the rash is clear and then slowly tapering to two or three times a week. "Stopping too early can result in a rebound flare," he warns.
Risks of Hydrocortisone for Eczema
As with all meds, it's important to be aware of the possible side effects. According to the National Institutes of Health (NIH), the side effects of topical hydrocortisone include:
Acne
Burning, dryness, itching, or redness of the skin
Changes to skin color
Rash around the mouth
Small white or red bumps on the skin
Unwanted hair growth
Long-term use of topical steroids can result in thinning of the skin due to decreased collagen production, says Dr. Mikkilineni. It can also lead to reduced efficacy because it can induce tachyphylaxis, the medical term for when a medication suddenly provides a poorer response or benefit than it once did. "This is likely due to the down regulation of the steroid receptors in the skin," Dr. Mikkilineni explains.
For these reasons, she typically transitions patients in need of long-term treatment to a non-steroidal option, such as (Elidel) pimecrolimus cream, (Protopic) tacrolimus, (Eucrisa) crisaborole, or (Opzelura) ruxolitinib. "After two weeks on the face or four weeks on the body I'll switch [patients] to the non-steroidal," she says. "Sometimes I will have them continue to use the steroid on the weekends and the non-steroidal on weekdays. Or use the steroid once daily and add the non-steroidal the second application over an additional week, before completely discontinuing the steroid after the overlap week and increasing the non-steroidal to twice a day."
Dr. Lal believes that topical steroids get a bad rap. "Risks of prolonged and improper use include acne, stretch marks, and cataracts," he says.
"However, I will tell you none of my patients have ever had any of these side effects because I thoroughly review and change steroid potency based on disease severity," says Dr. Lal. "Topical steroids are not dangerous when used frequently during eczema flare-ups and for long-term low maintenance. Don't be afraid of it!"
By keeping a record of your flare-ups and how your symptoms respond to hydrocortisone and different other eczema treatments and staying in close contact with your doctor, you'll feel more in control over your treatment plan—and your skin.
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