Mildison Lipocream

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Mildison Lipocream contains hydrocortisone 1% in a lipid-rich emollient base, designed to deliver mild corticosteroid anti-inflammatory action alongside moisturising skin barrier support.

Licensed in the United Kingdom for the treatment of mild inflammatory skin conditions, Mildison Lipocream is commonly prescribed for atopic eczema, contact dermatitis, seborrhoeic dermatitis, and allergic skin reactions.

Its dual-action formulation makes it particularly suitable for patients with dry, sensitive, or atopic skin where both inflammation and impaired skin barrier function need to be addressed simultaneously.

Eczema and dermatitis are among the most common dermatological conditions seen in UK general practice, affecting approximately 1 in 5 children and 1 in 10 adults.

Mild topical corticosteroids such as hydrocortisone 1% form the first-line pharmacological treatment for mild eczema flares, as recommended by NICE Clinical Guideline CG57.

This page provides a detailed clinical overview of Mildison Lipocream, including how it works, application guidance, side effects, safety warnings, and how to obtain a prescription in the UK.

Important safety information about Mildison Lipocream

Before reading further, note the following key safety points about Mildison Lipocream.

• Use the smallest amount needed to control symptoms, for the shortest time necessary.
• Do not apply to infected skin unless the infection is being treated at the same time.
• Avoid prolonged use on the face, as facial skin is particularly susceptible to corticosteroid side effects.
• Always use emollients alongside topical corticosteroids as the foundation of eczema management.
• Do not use under occlusive dressings unless directed by a specialist.

What is eczema

Eczema (also called atopic dermatitis when it occurs as part of the atopic triad alongside asthma and allergic rhinitis) is a chronic, relapsing inflammatory skin condition characterised by dry, itchy, red, and sometimes cracked or weeping skin.

The underlying pathology involves a combination of genetic predisposition (particularly filaggrin gene mutations affecting skin barrier proteins), immune dysregulation with a T-helper type 2 (Th2) skewed inflammatory response, and environmental triggers.

The impaired skin barrier in eczema allows increased transepidermal water loss, leading to dryness and susceptibility to irritants, allergens, and microbial colonisation (particularly by Staphylococcus aureus).

This drives a cycle of inflammation, itching, scratching, and further barrier damage.

Effective eczema management therefore requires both restoration of the skin barrier (through regular emollient use) and suppression of the inflammatory response (through topical corticosteroids or other anti-inflammatory agents).

Eczema in the UK

Atopic eczema affects approximately 6 million adults and 1.6 million children in the UK. It is the most common reason for referral to dermatology services.

The majority of cases are mild to moderate and can be managed effectively in primary care with emollients and mild topical corticosteroids.

NICE CG57 provides a stepwise approach to eczema management, beginning with emollients and mild corticosteroids and escalating to moderate or potent corticosteroids, calcineurin inhibitors, and systemic therapies only when lower steps have proven insufficient.

How Mildison Lipocream works: mechanism of action

Hydrocortisone is an endogenous glucocorticoid (identical to the cortisol produced naturally by the adrenal cortex) and is the mildest topical corticosteroid available.

When applied to inflamed skin, hydrocortisone diffuses across the cell membrane and binds to the glucocorticoid receptor in the cytoplasm.

The receptor-ligand complex then moves to the nucleus, where it influences gene transcription to suppress the production of pro-inflammatory mediators including interleukins (IL-1, IL-6), tumour necrosis factor-alpha (TNF-alpha), prostaglandins, and leukotrienes.

The clinical effects of this anti-inflammatory activity include reduction of redness (erythema), swelling (oedema), heat, itching (pruritus), and the formation of vesicles or papules.

Hydrocortisone also reduces the migration of inflammatory cells (neutrophils, eosinophils, and lymphocytes) into the affected skin, dampening the inflammatory infiltrate that characterises eczema flares.

The Lipocream formulation distinguishes Mildison from standard hydrocortisone cream.

The lipid-rich base contains a higher proportion of fatty substances than conventional creams, which helps to occlude the skin surface, reduce transepidermal water loss, and restore the depleted lipid lamellae of the stratum corneum.

This emollient action complements the anti-inflammatory effect of hydrocortisone, providing symptomatic relief from dryness and tightness while treating the underlying inflammation.

Patients with atopic skin often find the Lipocream base more comfortable and less drying than standard cream formulations.

Clinical evidence and national guidelines

Topical hydrocortisone has been in clinical use for over 60 years and is one of the most extensively studied topical corticosteroids.

Its efficacy and safety profile are well established in both adults and children.

NICE Clinical Guideline CG57 (Atopic eczema in under 12s) and NICE Clinical Knowledge Summary for eczema in adults both recommend mild topical corticosteroids as first-line treatment for mild eczema flares, with step-up to moderate-potency agents such as clobetasone butyrate or betamethasone valerate 0.025% for more resistant or widespread disease.

The BNF classifies topical corticosteroids into four potency categories: mild, moderate, potent, and very potent.

Hydrocortisone 1% falls into the mild category, making it suitable for use on delicate areas (face, flexures, genital skin) and in children, where the risk of local side effects from stronger agents is a concern.

The National Eczema Society and Primary Care Dermatology Society both endorse the use of mild topical corticosteroids for short courses to treat mild eczema flares, followed by step-down to emollient-only maintenance.

A Cochrane systematic review of topical corticosteroids for atopic eczema confirmed that even mild-potency agents significantly reduce disease severity compared with vehicle alone, with a low incidence of adverse effects when used appropriately.

The review emphasised that patient education about correct application, adequate quantities, and appropriate treatment duration are key to maximising benefit and minimising risk.

Dosage and application guidance

Mildison Lipocream should be applied thinly and evenly to the affected areas of skin once or twice daily, as directed by your prescriber.

The aim is to use the minimum amount necessary to control the flare, for the shortest duration needed.

Fingertip units

The fingertip unit (FTU) is a practical guide to the correct quantity of cream.

One FTU is the amount of cream squeezed from the tip of an adult index finger to the first crease of that finger (approximately 0.5 grams).

This quantity covers an area of skin equivalent to approximately two flat adult hands. The following table gives approximate FTU requirements for different body areas in adults.

• Face and neck: 2.5 FTUs
• One arm: 3 FTUs
• One hand (both sides): 1 FTU
• One leg: 6 FTUs
• One foot: 2 FTUs
• Trunk (front): 7 FTUs
• Trunk (back including buttocks): 7 FTUs

For children, smaller quantities are needed. Your prescriber or pharmacist can provide age-specific guidance. In general, children require approximately one quarter to one half of the adult FTU amounts, depending on age and body size.

Treatment duration

For mild eczema flares, a course of 7 to 14 days is usually sufficient to bring the inflammation under control.

If the eczema has not improved after 7 days of consistent use, review with your GP or prescriber is advised, as a stronger corticosteroid, a different diagnosis, or treatment of secondary infection may be needed.

Do not continue using Mildison Lipocream for more than 14 days without medical review.

Emollient use

Emollients (moisturisers) are the foundation of eczema management and should be used liberally and frequently (at least twice daily, and more often if the skin is very dry).

When using Mildison Lipocream, apply the emollient first and wait at least 30 minutes before applying the corticosteroid.

Alternatively, apply the corticosteroid first and the emollient at least 30 minutes later. This separation prevents dilution of the active ingredient and ensures both products are absorbed effectively.

Side effects of Mildison Lipocream

Local side effects

Mild burning, stinging, or itching at the application site is the most commonly reported side effect and is usually transient, resolving within a few minutes.

Contact sensitisation to hydrocortisone or one of the excipients in the Lipocream base can occur, presenting as worsening redness, itching, or rash at the application site.

If this occurs, stop using the cream and consult your prescriber. Patch testing may be needed to identify the specific allergen.

Effects of prolonged use

The following side effects are associated with prolonged or excessive use of topical corticosteroids, even at mild potency. Skin thinning (atrophy) with visible blood vessels (telangiectasia).

Stretch marks (striae), particularly in skin folds and on the inner thighs. Increased hair growth (hypertrichosis) at the application site. Delayed wound healing.

Perioral dermatitis (a papular rash around the mouth) with prolonged facial use. Steroid-induced acne or worsening of existing acne. Depigmentation (lightening of skin colour) in darker skin tones.

These effects are more likely on thin skin areas such as the eyelids, face, neck, groin, and axillae, and in young children. Using the cream for the shortest effective duration and at the lowest effective frequency minimises these risks.

Systemic side effects

Systemic absorption of hydrocortisone from topical application at 1% strength is very low in adults, and clinically significant systemic effects (such as adrenal suppression, Cushing syndrome features, or growth retardation in children) are extremely rare with appropriate use.

However, in infants and young children with a high surface-area-to-body-weight ratio, prolonged or widespread application may carry a marginally higher risk, and medical supervision is essential.

When to seek medical advice

Contact your GP, pharmacist, or NHS 111 if the treated area worsens, shows signs of infection (increased redness, warmth, swelling, pus, or crusting), or if a rash develops at a new site.

Seek emergency care by calling 999 or attending A&E if you experience signs of a severe allergic reaction including facial swelling, throat tightness, difficulty breathing, or widespread hives.

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

Warnings and precautions

Skin infections

Do not apply Mildison Lipocream to skin that is actively infected with bacteria, viruses, or fungi unless the infection is being treated concurrently with an appropriate antimicrobial agent.

Topical corticosteroids suppress local immune responses and can mask the clinical signs of infection, allowing it to spread or worsen.

Common skin infections that must be addressed include impetigo (often caused by Staphylococcus aureus or Streptococcus pyogenes), herpes simplex (cold sores), fungal infections such as tinea corporis (ringworm) or tinea pedis (athlete's foot), and scabies.

Facial use

Facial skin is thinner and more permeable than skin on the body, making it more susceptible to the thinning, telangiectasia, and perioral dermatitis that can result from topical corticosteroid use.

If facial application is necessary, limit treatment to 5 to 7 days unless your prescriber advises otherwise.

Avoid the periorbital area (around the eyes), as prolonged corticosteroid use near the eyes has been associated with glaucoma and cataract formation.

Use in children

Mildison Lipocream is suitable for use in children, including infants, under medical supervision.

Children have a higher surface-area-to-body-weight ratio and thinner skin than adults, which increases the potential for systemic absorption. Use the smallest effective amount for the shortest duration.

Nappy rash should not be treated with topical corticosteroids unless specifically advised by a healthcare professional, because the occlusive environment of the nappy area increases absorption.

Pregnancy and breastfeeding

Mild topical corticosteroids such as hydrocortisone 1% are generally considered safe for use during pregnancy when applied sparingly to small areas for short periods.

The UKTIS (UK Teratology Information Service) advises that there is no convincing evidence of harm from topical corticosteroid use in pregnancy when used at recommended doses.

However, extensive or prolonged use should be avoided. Breastfeeding mothers should avoid applying the cream to the breast area and wash their hands before handling the infant.

How to get a Mildison Lipocream prescription in the UK

Mildison Lipocream is classified as a prescription-only medicine (POM) in the UK.

You can obtain a prescription from your GP, practice nurse, an authorised online prescriber registered with the GPhC, or through a hospital dermatology clinic.

Note that standard hydrocortisone 1% cream (without the Lipocream base) is available over the counter from pharmacies for certain conditions including insect bites, mild eczema, and contact dermatitis, but Mildison Lipocream specifically requires a prescription.

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

Patients in England who require frequent prescriptions may benefit from a prescription prepayment certificate (PPC), which provides unlimited prescriptions for a fixed annual or quarterly fee.

Living with eczema: practical management

Managing eczema effectively requires a combination of pharmacological treatment and lifestyle measures. Regular and liberal emollient use is the single most important step.

Choose a fragrance-free, soap-free emollient that you find comfortable and are willing to use consistently. Common emollients prescribed on the NHS include Cetraben, Doublebase, Epaderm, and Dermol.

Use your emollient as a soap substitute in the bath or shower as well as a leave-on moisturiser.

Identify and avoid triggers where possible.

Common eczema triggers include biological washing powders, fragranced soaps and shower gels, woollen or synthetic clothing worn next to the skin, extremes of temperature, house dust mites, pet dander, and psychological stress.

Keep fingernails short to reduce skin damage from scratching. Wear cotton gloves at night if scratching during sleep is a problem.

Attend regular reviews with your GP or practice nurse to ensure your treatment plan is working and to step treatment up or down as needed.

The NICE eczema management pathway recommends a stepwise approach: emollients alone for very mild disease, mild topical corticosteroids for mild flares, moderate corticosteroids for moderate flares, and referral to a dermatologist for severe or refractory cases.

When to seek urgent medical advice

Most eczema flares can be managed at home with emollients and mild topical corticosteroids.

However, seek medical advice promptly if the eczema worsens rapidly despite treatment, if you notice signs of bacterial skin infection (spreading redness, warmth, swelling, pain, yellow crusting, or pus), or if you develop clusters of small painful blisters which may indicate eczema herpeticum (a potentially serious viral complication caused by herpes simplex virus).

Eczema herpeticum requires urgent antiviral treatment. Contact your GP urgently, call NHS 111, or attend A&E if eczema herpeticum is suspected.

For any life-threatening allergic reaction, call 999 immediately.

Sources

• Mildison Lipocream, Summary of Product Characteristics (EMC)
• Hydrocortisone (topical), British National Formulary (BNF)
• NICE CG57: Atopic eczema in under 12s
• NICE CKS: Eczema, atopic
• Atopic eczema, NHS
• MHRA Yellow Card Scheme