Locoid

Locoid contains hydrocortisone butyrate 0.1%, a moderately potent topical corticosteroid used to treat inflammatory skin conditions such as eczema (dermatitis), psoriasis, and other steroid-responsive dermatoses.

It is available as a cream, ointment, and scalp lotion. Locoid reduces redness, itching, swelling, and irritation.

It is a prescription-only medicine (POM) in the United Kingdom, manufactured by LEO Pharma.

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Locoid is a prescription-only topical corticosteroid containing hydrocortisone butyrate 0.1%.

It is classified as moderately potent on the UK corticosteroid potency scale and is used to treat a range of inflammatory skin conditions, including eczema (atopic dermatitis, contact dermatitis, and seborrhoeic dermatitis), psoriasis, and other steroid-responsive dermatoses.

Locoid is available as a cream, ointment, and scalp lotion (Locoid Crelo). It works by reducing the inflammatory response in the skin, alleviating redness, swelling, itching, and scaling.

Hydrocortisone butyrate should not be confused with plain hydrocortisone 1%, a mild corticosteroid available without prescription; the butyrate ester significantly increases the anti-inflammatory potency.

Inflammatory skin diseases are among the most common conditions seen in general practice in the United Kingdom.

Eczema alone affects approximately 1 in 5 children and 1 in 12 adults. Psoriasis affects around 2% of the UK population.

These conditions are chronic, often relapsing and remitting, and can substantially affect quality of life through physical discomfort, sleep disturbance, and psychological impact.

Topical corticosteroids have been a cornerstone of dermatological treatment for over 60 years and, when used correctly, are safe and effective.

This page provides a comprehensive clinical guide to Locoid, covering how it works, when to use it, dosage, side effects, safety warnings, and how to obtain a prescription in the UK.

Important safety information about Locoid

Before reading further, note these essential safety points.

  • Locoid is a prescription-only medicine and must be used as directed by your prescriber.
  • Do not use on infected skin unless combined with appropriate antimicrobial treatment.
  • Avoid prolonged use on the face, groin, or axillae, as these areas are more prone to skin thinning.
  • Use the lowest amount for the shortest time needed to control symptoms.
  • Always use emollients alongside topical corticosteroids as part of your daily skincare routine.

Understanding inflammatory skin conditions

Eczema (dermatitis) is a group of conditions characterised by inflamed, itchy, red, and often dry or weeping skin.

Atopic eczema is the most common form, typically beginning in childhood and associated with a personal or family history of atopy (asthma, hay fever, and eczema).

It is driven by a combination of skin barrier dysfunction (often related to filaggrin gene mutations) and immune dysregulation, with an overactive Th2 immune response producing inflammation.

Contact dermatitis results from skin exposure to irritants (irritant contact dermatitis) or allergens (allergic contact dermatitis).

Seborrhoeic dermatitis, which affects oily areas such as the scalp, face, and chest, is associated with the skin yeast Malassezia.

Psoriasis is a chronic, immune-mediated inflammatory skin disease characterised by well-demarcated, raised, red plaques covered with silvery-white scales.

It is driven by an overactive Th17 immune response, leading to accelerated skin cell turnover.

Psoriasis can affect any body site but most commonly appears on the elbows, knees, scalp, and lower back.

Both eczema and psoriasis are managed with a stepwise approach, starting with emollients and mild topical corticosteroids and escalating to more potent preparations or systemic treatments as needed.

How hydrocortisone butyrate works: mechanism of action

Hydrocortisone butyrate is a synthetic corticosteroid ester.

After application to the skin, it penetrates the stratum corneum and binds to intracellular glucocorticoid receptors within keratinocytes, fibroblasts, and immune cells.

The activated receptor complex translocates to the cell nucleus and modulates gene transcription.

This produces several anti-inflammatory effects: suppression of pro-inflammatory cytokines (including interleukins 1, 2, and 6, tumour necrosis factor alpha, and interferon gamma), inhibition of phospholipase A2 (reducing prostaglandin and leukotriene synthesis), reduction of capillary permeability (decreasing oedema), and inhibition of the migration and activation of inflammatory cells (neutrophils, lymphocytes, and monocytes).

The butyrate ester modification enhances lipophilicity and skin penetration compared with plain hydrocortisone, resulting in greater anti-inflammatory activity at a lower concentration (0.1% vs 1%).

This places hydrocortisone butyrate in the moderately potent category, above mild preparations (hydrocortisone 0.5 to 1%) but below potent preparations (betamethasone valerate 0.1%, mometasone furoate 0.1%) and very potent preparations (clobetasol propionate 0.05%).

The UK corticosteroid potency ladder

The British National Formulary (BNF) classifies topical corticosteroids into four potency groups.

Mild preparations include hydrocortisone 0.5 to 1%, suitable for mild eczema and use on the face and flexures.

Moderately potent preparations include hydrocortisone butyrate 0.1% (Locoid), clobetasone butyrate 0.05% (Eumovate), and fludroxycortide 0.0125%. Potent preparations include betamethasone valerate 0.1% (Betnovate), mometasone furoate 0.1%, and fluticasone propionate.

Very potent preparations include clobetasol propionate 0.05% (Dermovate) and diflucortolone valerate 0.3%.

Choosing the correct potency depends on the severity and site of the condition, the patient's age, and the treatment duration required.

NICE clinical guideline CG57 (atopic eczema in under-12s) and quality standard QS44 recommend a stepped approach: emollients for all patients, mild corticosteroids for mild eczema, moderately potent corticosteroids for moderate eczema, and potent corticosteroids under specialist supervision for severe eczema.

In adults, NICE guideline NG169 reinforces the importance of emollient use, appropriate corticosteroid potency selection, and avoidance of prolonged continuous use.

When to use Locoid

Locoid is appropriate for moderate inflammatory skin conditions that have not responded adequately to mild corticosteroids or emollients alone.

Common indications include moderate atopic eczema (especially on the limbs and trunk), contact dermatitis, discoid eczema, and mild to moderate psoriasis plaques on the body.

It may be used for short courses on the face or flexures under medical supervision, though milder preparations are generally preferred for these sites.

The scalp lotion formulation (Locoid Crelo) is particularly useful for scalp eczema and psoriasis, where cream and ointment formulations are difficult to apply.

Dosage and application

Apply Locoid thinly to the affected area once or twice daily, using the fingertip unit (FTU) method to measure an appropriate amount.

One FTU covers an area approximately twice the size of a flat adult hand. Gently massage into the skin until absorbed.

Treatment courses should typically last 7 to 14 days for acute flares, with review by your prescriber.

For chronic conditions such as eczema, your prescriber may recommend intermittent maintenance therapy (for example, applying Locoid on 2 to 3 days per week) combined with daily emollients.

Choose the appropriate formulation for the skin site: cream for moist, weeping, or flexural areas; ointment for dry, thickened, or scaly skin; and scalp lotion for the scalp.

Apply emollients liberally and frequently alongside Locoid, leaving at least 30 minutes between applications.

Side effects of hydrocortisone butyrate

Local side effects

Short-term use of Locoid at the recommended frequency carries a low risk of local side effects.

Mild stinging or burning on application is the most commonly reported effect and usually subsides quickly.

With prolonged or excessive use, skin thinning (atrophy), stretch marks (striae), visible small blood vessels (telangiectasia), easy bruising, perioral dermatitis, acne, rosacea, hypopigmentation, and delayed wound healing may develop.

These are more likely on thin-skinned areas and with occlusive application.

Systemic side effects

Systemic absorption from a moderately potent corticosteroid used over limited areas for short durations is negligible.

However, prolonged application over large body surface areas, under occlusion, on broken skin, or in young children can lead to measurable systemic effects, including adrenal suppression.

Features of systemic corticosteroid excess (Cushing syndrome) are rare but have been reported with misuse of topical corticosteroids.

When to seek medical advice

Contact your GP if you notice skin thinning, stretch marks, visible blood vessels, persistent redness, or worsening of your skin condition during treatment.

These may indicate that the corticosteroid potency is too high or that the condition requires reassessment.

Report suspected adverse reactions to the MHRA via the Yellow Card scheme at yellowcard.mhra.gov.uk .

Warnings and precautions

Contraindications

Locoid must not be applied to untreated bacterial, fungal, or viral skin infections, rosacea, acne vulgaris, or perioral dermatitis. It should not be used on ulcerated skin or under occlusive dressings unless directed by a specialist.

Sensitive skin sites

The face, neck, groin, axillae, and skin folds have thinner skin and are more susceptible to corticosteroid side effects.

Use the mildest effective preparation for the shortest time on these areas. Avoid prolonged periocular application due to the risk of glaucoma and cataracts.

Use in children

Children have a higher body surface area to weight ratio, increasing the risk of systemic absorption. Use the lowest effective potency and shortest duration. Regular growth monitoring is recommended in children requiring ongoing topical corticosteroid therapy.

Corticosteroid withdrawal

Prolonged frequent use, particularly on the face and genital area, can lead to topical corticosteroid withdrawal (red skin syndrome) when treatment is stopped. Symptoms include burning, stinging, and diffuse redness. If suspected, taper gradually rather than stopping abruptly.

Pregnancy and breastfeeding

Use during pregnancy only if the benefit justifies the risk, using the mildest effective preparation for the shortest time. Avoid application to the breast area during breastfeeding.

How to get Locoid in the UK

Locoid is a prescription-only medicine. Your GP or dermatologist can prescribe it following a clinical assessment of your skin condition.

Authorised online prescribers registered with the General Pharmaceutical Council (GPhC) can also issue prescriptions.

The standard NHS prescription charge in England is currently 9.90 pounds per item; prescriptions are free in Scotland, Wales, and Northern Ireland.

Living with eczema and inflammatory skin conditions

Managing inflammatory skin conditions requires a consistent daily skincare routine.

Use emollients (moisturisers) liberally and frequently, even when the skin appears clear, to maintain the skin barrier and reduce the frequency of flares.

Avoid known triggers where possible, such as harsh soaps, detergents, fragrances, and extremes of temperature. Wear soft, breathable fabrics (cotton is generally well tolerated).

Keep nails short to minimise damage from scratching. Psychological support may be helpful for patients whose quality of life is significantly affected.

NICE recommends that healthcare professionals assess the impact of eczema on daily activities and psychological wellbeing at each review.

Sources

Medical information

Hydrocortisone butyrate is a synthetic corticosteroid ester classified as moderately potent (group III on the UK potency ladder, which ranges from mild to very potent). It should not be confused with plain hydrocortisone 1%, which is a mild corticosteroid available over the counter. The butyrate ester enhances skin penetration and anti-inflammatory potency while allowing a lower concentration (0.1%) to be used. Hydrocortisone butyrate acts by binding to intracellular glucocorticoid receptors in skin cells, modulating gene transcription to suppress the production of pro-inflammatory cytokines, prostaglandins, and leukotrienes. It also reduces capillary permeability and inhibits the migration of inflammatory cells into the affected area. The clinical result is a reduction in redness, swelling, itching, and scaling. Locoid is classified as POM in the United Kingdom.

Dosage guidance

Apply Locoid thinly to the affected area once or twice daily. The frequency depends on the severity of the condition and your prescriber's instructions. For most inflammatory dermatoses, once-daily application is sufficient for maintenance, while twice-daily application may be used during acute flares. Use the fingertip unit (FTU) method to measure the correct amount. One FTU is the amount of cream or ointment squeezed from a standard tube along the length of an adult's fingertip (from the tip to the first crease). One FTU covers an area approximately twice the size of an adult's flat hand. For example, one FTU is usually sufficient for one hand (front and back), two FTUs for one arm, and six FTUs for one leg. Gently massage the preparation into the skin until it has been absorbed. Do not apply to broken or infected skin unless your prescriber has specifically instructed this alongside appropriate antimicrobial treatment. Wash your hands after application unless you are treating the hands. Locoid cream is generally preferred for moist or weeping areas, while the ointment is more suitable for dry, thickened, or lichenified skin. The scalp lotion (Locoid Crelo) is specifically formulated for use on the scalp, where creams and ointments are impractical. Treatment with moderately potent corticosteroids should be limited to the shortest effective duration. A typical course is 7 to 14 days for an acute flare, after which the frequency should be reduced or the treatment stepped down to a milder corticosteroid or an emollient alone. Continuous long-term use of moderately potent corticosteroids increases the risk of local side effects including skin thinning. For children, use the lowest potency and shortest duration appropriate for the condition. Locoid can be used in children but with closer supervision and for shorter periods. Avoid using on the face, groin, or axillae for prolonged periods, as these areas have thinner skin and are more susceptible to steroid side effects. Apply emollients liberally and frequently alongside Locoid. NICE recommends leaving at least 30 minutes between applying an emollient and a topical corticosteroid to allow the emollient to absorb and to avoid diluting the active ingredient.

Side effects and warnings

Common side effects of Locoid are generally local and include a mild burning or stinging sensation on application, particularly on inflamed or broken skin. This usually subsides within a few minutes. Itching, dryness, and skin irritation at the application site have been reported. With prolonged or inappropriate use, moderately potent topical corticosteroids can cause local adverse effects. Skin thinning (atrophy) is the most clinically significant concern and presents as fragile, transparent skin with visible blood vessels (telangiectasia), easy bruising, and stretch marks (striae). These changes are more likely on thin-skinned areas such as the face, neck, axillae, and groin and may be irreversible if treatment is not stopped promptly. Other local effects of prolonged use include perioral dermatitis (a rash around the mouth), acne or worsening of pre-existing acne, rosacea or worsening of rosacea, hypertrichosis (excess hair growth at the site of application), hypopigmentation (lightening of the skin), and delayed wound healing. Contact sensitisation (allergic dermatitis to the corticosteroid or a component of the vehicle) is uncommon but should be suspected if the condition worsens despite treatment. Systemic absorption from topical corticosteroids is generally low but can become clinically significant with prolonged use over large body surface areas, under occlusive dressings, on thin skin, or in young children. Systemic effects include adrenal suppression (suppression of the hypothalamic-pituitary-adrenal axis), Cushing syndrome features (weight gain, moon face, striae), hyperglycaemia, and, in children, growth retardation. These are rare with moderately potent preparations used appropriately. Topical corticosteroids can mask or exacerbate skin infections, including bacterial, fungal, and viral infections. Tinea incognito (fungal infection modified by steroid use) is a recognised complication. Contact your GP or call NHS 111 if you notice skin thinning, stretch marks, persistent redness, or worsening of your skin condition. Report suspected adverse reactions to the MHRA via the Yellow Card scheme at yellowcard.mhra.gov.uk.

Locoid is contraindicated in patients with known hypersensitivity to hydrocortisone butyrate or any excipient in the formulation.

It must not be used on untreated bacterial, fungal, or viral skin infections (including herpes simplex, varicella, and impetigo), acne vulgaris, rosacea, perioral dermatitis, or perianal and genital pruritus without underlying dermatosis.

Avoid applying Locoid to the face for prolonged periods. Facial skin is thin and particularly vulnerable to corticosteroid side effects, including skin thinning, telangiectasia, and perioral dermatitis.

If facial application is necessary, limit treatment to 5 to 7 days and use a milder preparation for maintenance.

Similarly, the groin, axillae, and skin folds (intertriginous areas) are at higher risk of local side effects.

Do not use Locoid under occlusive dressings unless specifically directed by your prescriber, as occlusion increases corticosteroid absorption and the risk of systemic and local side effects.

In children, use the lowest effective potency for the shortest duration. Children have a higher body surface area to weight ratio, increasing the risk of systemic absorption.

Growth should be monitored in children requiring prolonged courses of topical corticosteroids.

Topical corticosteroid withdrawal (sometimes called topical steroid withdrawal or red skin syndrome) is a recognised condition that can occur after prolonged, frequent use of topical corticosteroids, particularly on the face and genital area.

Symptoms include burning, stinging, and intense redness that may spread beyond the original treatment area.

If you suspect this is occurring, discuss a gradual tapering plan with your prescriber rather than stopping abruptly. Locoid should be used with caution in patients with psoriasis.

Potent and moderately potent topical corticosteroids can trigger rebound flares, pustular psoriasis, or generalised erythroderma if applied to large areas and then stopped abruptly.

A supervised tapering approach is recommended. Pregnancy and breastfeeding: topical corticosteroids should be used during pregnancy only if the potential benefit justifies the potential risk.

Use the mildest effective preparation for the shortest time. Avoid application to the breast area during breastfeeding to prevent the infant ingesting the preparation.

Keep Locoid away from the eyes. If accidental ocular exposure occurs, rinse thoroughly with water.

Prolonged periocular use of topical corticosteroids can increase the risk of glaucoma and posterior subcapsular cataracts.

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