Hydrocortisone

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Hydrocortisone on Prescriptsy

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Hydrocortisone cream and ointment are mild topical corticosteroid preparations used to treat a range of inflammatory skin conditions.

Available in 0.5% and 1% strengths, hydrocortisone reduces redness, itching, swelling, and discomfort caused by eczema, dermatitis, insect bites, and mild allergic skin reactions.

Hydrocortisone 1% is one of the few topical corticosteroids available over the counter from pharmacies in the UK (for adults and children aged 10 and over), while higher strengths and combination products require a prescription.

This page provides a comprehensive clinical overview of topical hydrocortisone, including how it works, when and how to use it, potential side effects, safety precautions, and how to obtain it in the United Kingdom.

Inflammatory skin conditions are extremely common in the UK.

Eczema (atopic dermatitis) alone affects around 1 in 5 children and 1 in 12 adults, making it one of the most frequently seen conditions in general practice.

Contact dermatitis, caused by direct skin exposure to irritants or allergens, is another common cause of skin inflammation.

Insect bites and stings cause localised inflammatory reactions that affect millions of people each summer.

For many of these conditions, a mild topical corticosteroid such as hydrocortisone is the first-line pharmacological treatment, offering rapid symptom relief with a well-established safety profile when used correctly.

Important safety information about hydrocortisone

Before reading further, note the following essential safety points about topical hydrocortisone.

• Do not use hydrocortisone on infected, broken, or weeping skin unless your doctor has prescribed an appropriate antimicrobial alongside it.
• Do not apply to the face for prolonged periods without medical advice.
• Do not use on acne, rosacea, perioral dermatitis, or skin affected by viral infections (cold sores, chickenpox, shingles).
• For over-the-counter use, do not exceed 7 days (14 days for insect bites) without consulting a pharmacist or GP.
• Apply emollients (moisturisers) at least 15 to 30 minutes before applying hydrocortisone.

Understanding skin inflammation

The skin is the body's largest organ and its primary barrier against the external environment.

When this barrier is disrupted by irritants, allergens, trauma (such as insect bites), or underlying immune dysregulation (as in eczema), an inflammatory response is triggered.

Immune cells release chemical mediators including histamine, prostaglandins, and cytokines, which cause blood vessels in the skin to dilate and become more permeable.

This produces the cardinal signs of inflammation: redness (erythema), swelling (oedema), heat, and itching (pruritus).

In eczema, the inflammatory response is driven by a complex interaction between a defective skin barrier (often involving mutations in the filaggrin gene), environmental triggers, and an overactive Th2 immune response.

In contact dermatitis, inflammation results from direct irritation (irritant contact dermatitis) or a delayed-type hypersensitivity reaction to a specific allergen (allergic contact dermatitis).

Insect bite reactions are a form of localised immune response to venom or saliva proteins injected into the skin.

Treatment of these conditions involves restoring the skin barrier (through regular emollient use), avoiding triggers where possible, and suppressing the inflammatory response with topical anti-inflammatory agents.

Topical corticosteroids, including hydrocortisone, are the mainstay of anti-inflammatory treatment for mild to moderate inflammatory skin disease.

How hydrocortisone works: mechanism of action

Hydrocortisone is a synthetic glucocorticoid identical in structure to cortisol, the body's own anti-inflammatory hormone.

When applied to the skin, it penetrates the epidermis and binds to intracellular glucocorticoid receptors in keratinocytes, fibroblasts, and immune cells.

The activated receptor complex translocates to the cell nucleus, where it modulates gene transcription. This results in several anti-inflammatory effects.

First, hydrocortisone suppresses the production of pro-inflammatory mediators, including prostaglandins (by inhibiting the enzyme phospholipase A2 and cyclo-oxygenase-2), leukotrienes, and cytokines such as interleukin-1, interleukin-6, and tumour necrosis factor-alpha.

Second, it inhibits the migration and activation of inflammatory cells (neutrophils, lymphocytes, monocytes, eosinophils, and mast cells) to the site of inflammation.

Third, it produces vasoconstriction of small blood vessels in the dermis, reducing redness and oedema.

Fourth, it reduces the permeability of capillary walls, limiting further fluid leakage into the surrounding tissue.

The combined effect is rapid reduction in redness, swelling, itching, and discomfort.

Hydrocortisone is classified as a mild (group I) corticosteroid in the BNF potency scale, which ranges from mild through moderate, potent, and very potent.

Its mild potency makes it the safest topical corticosteroid for use on sensitive areas (face, neck, groin, axillae) and in children.

Clinical evidence and UK prescribing guidance

Topical corticosteroids have been the cornerstone of inflammatory skin disease management since their introduction in the 1950s.

Hydrocortisone was among the first to be used clinically and remains the most widely prescribed mild topical corticosteroid in UK general practice.

NICE clinical guideline CG57 (atopic eczema in under-12s) and NICE guideline NG224 (atopic eczema) recommend using the least potent topical corticosteroid that effectively controls symptoms.

For mild eczema, hydrocortisone 1% is recommended as first-line treatment, applied for short periods to active flares, alongside regular emollient use.

The BNF provides clear potency rankings for topical corticosteroids. Hydrocortisone 0.5% and 1% are classified as mild. Clobetasone butyrate 0.05% (Eumovate) is moderate.

Betamethasone valerate 0.1% (Betnovate) is potent. Clobetasol propionate 0.05% (Dermovate) is very potent.

Prescribers use these rankings to select the appropriate strength for the condition, body site, and patient age.

Stepping up to a more potent steroid is considered only if a milder one fails to control the condition.

For contact dermatitis, the primary treatment is identification and avoidance of the offending irritant or allergen, supported by emollients and topical corticosteroids to manage active inflammation. For insect bites, hydrocortisone 1% is recommended alongside oral antihistamines for symptomatic relief.

Topical corticosteroid potency and choosing the right product

The potency of a topical corticosteroid refers to its ability to produce vasoconstriction and suppress inflammation when applied to the skin.

Potency depends on the molecule used, its concentration, and the vehicle (cream, ointment, lotion). Hydrocortisone at 0.5% to 1% is the least potent topical corticosteroid in routine use.

It is appropriate for mild inflammatory conditions, sensitive body sites, and in children.

Ointments are generally slightly more potent than creams of the same concentration because the occlusive base enhances drug penetration.

It is a common misconception that all topical steroids are dangerous and should be avoided.

Steroid phobia, a widespread phenomenon in the UK, leads many patients (and parents of children with eczema) to under-treat inflammatory skin conditions, resulting in unnecessary suffering, poor disease control, and increased risk of secondary infection.

When used correctly at the appropriate potency and for the recommended duration, topical corticosteroids are safe and effective.

Your GP, dermatologist, or pharmacist can provide reassurance and education about their safe use.

How to apply hydrocortisone correctly

Effective use of topical hydrocortisone requires correct application technique. Wash your hands before and after application.

Apply a thin layer to the affected areas only, gently rubbing or patting the preparation into the skin.

Use the fingertip unit system to measure the correct amount: one FTU (approximately 0.5 g) covers an area of skin equal to two flat adult palms.

For children, smaller fingertip units apply, and the BNF provides age-specific guidance on the number of FTUs needed for different body regions.

If you are also using an emollient (which is recommended for virtually all inflammatory skin conditions), apply the emollient first.

Wait at least 15 to 30 minutes to allow it to absorb before applying hydrocortisone.

This prevents the emollient from diluting the corticosteroid or spreading it to unaffected areas.

Some dermatologists recommend separating emollient and corticosteroid applications by different times of day (for example, emollient in the morning and evening, corticosteroid at lunchtime) to simplify the routine.

Apply hydrocortisone once or twice daily as directed. For most conditions, once daily application is sufficient. Do not apply more frequently than recommended, as this does not improve efficacy but increases the risk of side effects.

Side effects of topical hydrocortisone

Local side effects

At 0.5% to 1% concentration, topical hydrocortisone has a very low risk of local side effects when used as directed.

Prolonged or excessive use (particularly on thin skin areas) may lead to skin thinning (atrophy), telangiectasia (visible thread veins), striae (stretch marks), easy bruising, and depigmentation.

These effects are largely reversible if the corticosteroid is stopped early.

Irreversible striae are rare with mild-potency preparations and occur mainly with prolonged use of potent or very potent steroids.

Contact sensitisation (allergic contact dermatitis to the corticosteroid itself or to a preservative or excipient in the formulation) is uncommon but should be suspected if the treated area becomes more inflamed despite ongoing treatment.

Patch testing by a dermatologist can confirm the diagnosis.

Systemic side effects

Systemic absorption of topical hydrocortisone is negligible at 0.5% to 1% used over small areas for short periods.

Significant systemic effects (including adrenal suppression, Cushing syndrome, or growth retardation in children) are essentially not seen with mild-potency preparations used as recommended.

The risk increases with higher-potency steroids, larger surface areas, occlusive dressings, prolonged use, and in infants (whose higher surface area to body weight ratio increases relative absorption).

When to seek urgent medical advice

Contact your GP or pharmacist if the skin condition does not improve within 7 days, worsens, or shows signs of infection (increased redness, warmth, swelling, pain, pus, or crusting).

Call NHS 111 or attend your GP urgently if you develop widespread skin changes or signs of an allergic reaction to the product.

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

Warnings and precautions

Conditions where hydrocortisone should not be used

Do not use topical hydrocortisone on skin infections caused by bacteria (such as impetigo or cellulitis), fungi (such as ringworm, athlete's foot, or candida), or viruses (cold sores, chickenpox, shingles) unless an appropriate antimicrobial has been prescribed alongside it.

Corticosteroids suppress local immune defence and can worsen infections. Do not use on acne, rosacea, or perioral dermatitis, as corticosteroids may exacerbate these conditions.

Use in children

Hydrocortisone is the most commonly prescribed topical corticosteroid for children in the UK. It is safe for short-term use in children when applied as directed by a prescriber.

Parents and carers should be educated about correct application, duration of use, and when to seek further advice.

Steroid phobia should be addressed proactively, as under-treatment of childhood eczema leads to avoidable suffering and complications.

Pregnancy and breastfeeding

Topical hydrocortisone may be used in pregnancy when clinically indicated, using the smallest amount for the shortest time. There is no evidence of harm at mild potency.

Avoid applying to the nipple area during breastfeeding, or wash thoroughly before feeding. Consult your GP or midwife for individual advice.

How to get hydrocortisone in the UK

Hydrocortisone 1% cream or ointment is available without a prescription from any pharmacy in the UK for adults and children aged 10 and over.

Your pharmacist will ask a few questions to confirm suitability before selling it.

For children under 10, or if a stronger topical corticosteroid is required, your GP can write a prescription.

Combination products (such as hydrocortisone with miconazole for fungal infections with inflammation, or hydrocortisone with fusidic acid for eczema with secondary bacterial infection) are prescription-only.

The 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 dermatitis: practical advice

Managing inflammatory skin conditions is a long-term process. Regular emollient use is the foundation: apply liberally and frequently, ideally three to four times daily and always after bathing.

Choose fragrance-free, soap-free cleansers and emollients. Avoid known triggers such as harsh detergents, perfumed products, woollen clothing, and extremes of temperature.

Keep fingernails short to minimise damage from scratching.

Use hydrocortisone promptly at the first sign of a flare to bring inflammation under control quickly, rather than waiting until symptoms are severe.

If eczema flares are frequent or do not respond to mild-potency steroids, ask your GP about a structured eczema management plan or referral to a dermatologist.

Sources

• Hydrocortisone Cream 1% w/w, Summary of Product Characteristics (EMC)
• Hydrocortisone (topical), British National Formulary (BNF)
• NICE NG224: Atopic eczema
• Eczema (atopic), NHS
• Hydrocortisone skin cream, NHS medicines guide
• MHRA Yellow Card Scheme