hydrocortisone (topical)
Acticort 100, Aeroseb-HC, Ala-Cort, Ala-Scalp, Anusol-HC, Bactine, Barriere-HC ◆, Cetacort, CortaGel, Cortate ◆, Cort-Dome, Cortizone, Delcort, Dermacort, Dermolate, Dermtex HC, Eldecort, Emo-Cort ◆, Hi-Cor, Hycort, Hydro-Tex, Hytone, LactiCare-HC, Nutracort, Penecort, Procort, Rectocort ◆, S-T Cort, Synacort, Tegrin HC, Texacort, Unicort ◆

hydrocortisone acetate
Anusol-HC, Cortaid, Cort-Dome, Cortef, Corticaine, Corticreme ◆, Cortoderm ◆, Gynecort, Hyderm ◆, Lanacort, Novohydrocort ◆, Orabase-HCA, Pharma-Cort, Rhulicort

hydrocortisone buteprate
Pandel

hydrocortisone butyrate
Locoid

hydrocortisone valerate
Westcort

Available forms
Available by prescription only
hydrocortisone
Aerosol: 1%
Cream: 2.5%
Gel: 1%
Lotion: 0.25%, 0.5%, 1%, 2%, 2.5%
Ointment: 0.5%, 1%, 2.5%
Solution: 1%
Stick, roll-on: 1%
hydrocortisone acetate
Cream: 1%
Lotion: 0.5%
Ointment: 0.5%, 1%
Paste: 0.5%
Rectal foam: 10%
Solution: 1%
Suppositories: 25 mg
hydrocortisone buteprate
Cream: 0.1%, 1%
hydrocortisone butyrate
Cream, ointment, solution: 0.1%
hydrocortisone valerate
Cream, ointment: 0.2% Available without a prescription
hydrocortisone
Cream: 0.5%, 1%
hydrocortisone acetate
Cream: 0.5%

Indications and dosages
 Inflammation of corticosteroid-responsive dermatoses, including those on face, groin, armpits, and under breasts; seborrheic dermatitis of scalp. Adults and children: Apply cream, lotion, ointment, foam, or aerosol sparingly once daily to q.i.d.
Aerosol administration
Shake can well. Direct spray onto affected area from a distance of 15 cm (6 inches). Apply for only 3 seconds (to avoid freezing tissues). Apply to dry scalp after shampooing; no need to massage or rub medication into scalp after spraying. Apply daily until acute phase is controlled, then reduce dosage to once to three times weekly, p.r.n., to maintain control.
Rectal administration
Shake can well. Apply once daily or b.i.d. for 2 to 3 weeks, then every other day, p.r.n.
 Dental lesions. Adults and children: Apply paste b.i.d. or t.i.d. and h.s.

Pharmacodynamics
Anti-inflammatory action: Hydrocortisone stimulates the synthesis of enzymes needed to decrease the inflammatory response. Hydrocortisone, a corticosteroid secreted by the adrenal cortex, is about 1.25 times more potent an anti-inflammatory agent than equivalent doses of cortisone, but both have twice the mineralocorticoid activity of the other glucocorticoids.
 Hydrocortisone 0.5%, 1%, and hydrocortisone acetate 0.5% are available without a prescription for the temporary relief of minor skin irritation, itching, and rashes caused by eczema, insect bites, soaps, and detergents.
 Hydrocortisone is also administered rectally as a retention enema for the temporary treatment of acute ulcerative colitis. Hydrocortisone acetate suspension is also available as a rectal suppository or aerosol foam suspension for the temporary treatment of inflammatory conditions of the rectum, such as hemorrhoids, cryptitis, proctitis, and pruritus ani.

Pharmacokinetics
Absorption: Absorption depends on potency of preparation, amount applied, and nature of skin at application site. It ranges from about 1% in areas with a thick stratum corneum (such as the palms, soles, elbows, and knees) to as high as 36% in areas where the stratum corneum is thinnest (face, eyelids, and genitals). Absorption increases in areas of skin damage, inflammation, or occlusion. Some systemic absorption occurs, especially through the oral mucosa.
Distribution: After topical application, drug is distributed throughout the local skin layers. Any drug absorbed into circulation is removed rapidly from the blood and distributed into muscle, liver, skin, intestines, and kidneys.
Metabolism: After topical administration, hydrocortisone is metabolized primarily in the skin. The small amount absorbed into systemic circulation is metabolized primarily in the liver to inactive compounds.
Excretion: Inactive metabolites are excreted by the kidneys, primarily as glucuronides and sulfates, but also as unconjugated products. Small amounts of metabolites are also excreted in feces.

Contraindications and precautions
Contraindicated in patients hypersensitive to drug.

Interactions
None significant.

Adverse reactions
GU: glucosuria.
Metabolic: hyperglycemia.
Skin: burning, pruritus, irritation, dryness, erythema, folliculitis, hypertrichosis, hypopigmentation, acneiform eruptions, allergic contact dermatitis; maceration, secondary infection, atrophy, striae, miliaria (with occlusive dressings).
Other: hypothalamic-pituitary-adrenal axis suppression, Cushing’s syndrome.

Effects on lab test results
• May increase glucose levels.

Overdose and treatment
No information available.

Special considerations
• Gently wash skin before applying. To prevent skin damage, rub in gently, leaving a thin coat. When treating hairy sites, part hair and apply directly to lesions.
• Avoid applying near eyes or mucous membranes or in ear canal; may be safely used on face, groin, and armpits and under breasts.
• If an occlusive dressing is applied and a fever develops, remove dressing.
• Stop drug if skin infection, striae, or atrophy occurs.
• When using aerosol near the face, cover patient’s eyes and warn against inhalation of spray. Aerosol contains alcohol and may cause irritation or burning when used on open lesions. Don’t spray longer than 3 seconds or from closer than 6 inches (15 cm) to avoid freezing tissues. If spray is applied to dry scalp after shampooing, drug need not be massaged into scalp.
• If antifungals or antibiotics are used concurrently, stop corticosteroid until infection is controlled.
• Continue treatment for a few days after lesions clear.
• Systemic absorption is likely with use of occlusive dressings, prolonged treatment, or extensive body surface treatment. Watch for symptoms.
• Monitor patient for fluid or electrolyte disturbances (sodium and fluid retention, potassium loss, hypokalemic alkalosis, negative nitrogen balance from catabolism of protein).
 ALERT Don’t confuse hydrocortisone with hydroxychloroquine.
Pediatric patients
• Avoid using plastic pants or tight-fitting diapers on treated areas in young children. Children may absorb larger amounts of drug and be more prone to systemic toxicity.

Patient education
• Teach patient or family member how to apply drug.
• If an occlusive dressing is used, advise patient to leave it in place for no longer than 12 hours each day and not to use the dressing on infected or exudative lesions.
• Tell patient to stop drug and report signs of systemic absorption, skin irritation or ulceration, hypersensitivity, infection, or lack of improvement.
• For enema administration. tell patient to lie on left side and retain fluid for 1 hour.
• Instruct patient to insert suppositories blunt end first after removing foil wrapper.
• For perianal application, instruct patient to place small amount of drug on a tissue and gently rub in.
• Tell patient to disassemble applicators or aerosol cap and clean with warm water after each use.

Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE THREATENING.
◆ Canada only
◇ Unlabeled clinical use