hydrocortisone (topical)

Therapeutic Classification: corticosteroids

Pharmacologic Classification: corticosteroids

Indications ⬆ ⬇

REMS

Management of inflammation and pruritis associated with various allergic/immunologic skin problems.

Action ⬆ ⬇

Suppress normal immune response and inflammation.

Therapeutic effects:

Suppression of dermatologic inflammation and immune processes.

Pharmacokinetics ⬆ ⬇

Absorption: Minimal. Prolonged use on large surface areas, application of large amounts, or use of occlusive dressings may ↑ systemic absorption.

Distribution: Remain primarily at site of action.

Metabolism/Excretion: Usually metabolized in skin; some have been modified to resist local metabolism and have a prolonged local effect.

Half-Life: 1.5–2 hr (plasma), 8–12 hr (tissue).

Time/Action Profile ⬆ ⬇

(response depends on condition being treated)

ROUTE	ONSET	PEAK	DURATION
Topical	mins–hrs	hrs–days	hrs–days

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity or known intolerance to glucocorticoid or components of vehicles (ointment or cream base, preservative, alcohol);
Untreated bacterial or viral infections.

Use Cautiously in:

Hepatic dysfunction;
Diabetes mellitus, cataracts, glaucoma, or tuberculosis (use of large amounts of high-potency agents may worsen condition);
Patients with pre-existing skin atrophy;
OB: Chronic high-dose usage may result in adrenal suppression in mother, growth suppression in children; children may be more susceptible to adrenal and growth suppression.

Adv. Reactions/Side Effects ⬆ ⬇

Derm: allergic contact dermatitis, atrophy, burning, dryness, edema, folliculitis, hypersensitivity reactions, hypertrichosis, hypopigmentation, irritation, maceration, miliaria, perioral dermatitis, secondary infection, striae

Misc: adrenal suppression (use of occlusive dressings, long-term therapy)

Interactions ⬆ ⬇

Drug-drug:

None significant.

Route/Dosage ⬆ ⬇

(Adults and Children ): Apply to affected area(s) 1–4 times daily (depends on product, preparation, and condition being treated).
(Adults ): Aerosol foam: 90 mg 1–2 times/day for 2–3 wk; then adjusted.

Availability ⬆ ⬇

(Generic available)

Cream: 0.5%Rx, OTC; 1%Rx, OTC; 2.5%
Gel: 0.5%Rx, OTC; 1%Rx, OTC
Ointment: 0.5%Rx, OTC; 1%Rx, OTC
Lotion: 0.25%; 0.5%Rx, OTC; 1%Rx, OTC; 2%; 2.5%
Solution: 1%
Spray: 0.5%Rx, OTC; 1%Rx, OTC
Rectal cream: 1%
Rectal aerosol: 10%
In combination with: acetic acid, antifungals, anti-infectives, antihistamines, urea, and benzoyl peroxide in various otic and topical preparations; acyclovir (Xerese). See Appendix [not included in this PDA edition].

Assessment ⬆ ⬇

Assess affected skin before and daily during therapy. Note degree of inflammation and pruritus. Notify health care professional if symptoms of infection (increased pain, erythema, purulent exudate) develop.

Lab Test Considerations:

Periodic adrenal function tests may be ordered to assess degree of hypothalamic-pituitary-adrenal (HPA) axis suppression in chronic topical therapy if suspected. Children and patients with dose applied to a large area, using an occlusive dressing, or using high-potency products are at highest risk for HPA suppression.
- May cause increased serum and urine glucose concentrations if significant absorption occurs.

Implementation ⬆ ⬇

Choice of vehicle depends on site and type of lesion. Ointments are more occlusive and preferred for dry, scaly lesions. Creams should be used on oozing or intertriginous areas, where the occlusive action of ointments might cause folliculitis or maceration. Creams may be preferred for aesthetic reasons even though they may be more drying to skin than ointments. Gels, aerosols, lotions, and solutions are useful in hairy areas.
Apply ointments, creams, or gels sparingly as a thin film to clean, slightly moist skin. Wash hands immediately after application. Apply occlusive dressing only if specified by health care professional.
- Apply lotion, solution, or gel to hair by parting hair and applying a small amount to affected area. Rub in gently. Protect area from washing, clothing, or rubbing until medication has dried. Hair may be washed as usual but not right after applying medication.

Patient/Family Teaching ⬆ ⬇

Instruct patient on correct technique of medication administration. Emphasize importance of avoiding the eyes. If a dose is missed, it should be applied as soon as remembered unless almost time for next dose.
Caution patient to use only as directed. Avoid using cosmetics, bandages, dressings, or other skin products over the treated area unless directed by health care professional.
Advise parents of pediatric patients not to apply tight-fitting diapers or plastic pants on a child treated in the diaper area; these garments work like an occlusive dressing and may cause more of the drug to be absorbed.
Advise patient to consult health care professional before using medicine for conditions other than indicated.
Instruct patient to inform health care professional if symptoms of underlying disease return or worsen or if symptoms of infection develop.

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Pronunciation ⬇

Classifications ⬆ ⬇