Locoid

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Locoid on Prescriptsy

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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

• Locoid Cream, Summary of Product Characteristics (EMC)
• Hydrocortisone butyrate, British National Formulary (BNF)
• NICE CG57: Atopic eczema in under-12s
• Atopic eczema, NHS
• Emollients, NHS
• MHRA Yellow Card Scheme