Hydrocortisone: Uses and Safety Considerations

What is hydrocortisone?

Hydrocortisone is a drug that belongs to a class of medications called corticosteroids. Corticosteroids work within the human body to block certain immune reactions that cause itching and inflammation (swelling). Hydrocortisone is available in multiple forms, including topical creams/ointments, oral pills, and rectal creams/suppositories. The topical creams come in over-the-counter and prescription strength, while the oral medications are only available by prescription. 

What is hydrocortisone cream used for?

The United States Food and Drug Administration (FDA) has approved topical hydrocortisone for treating itching and inflammation related to dermatitis and other skin conditions that cause itching, such as bug bites and psoriasis. Hydrocortisone is often also used to manage conditions such as sunburn, redness of the skin, dermatitis (skin irritation), and skin swelling. However, hydrocortisone is not FDA-approved for these uses. Rectal hydrocortisone is most often used to treat hemorrhoids, but it can also be used for conditions such as proctitis (swelling of the rectum) and ulcerative colitis. 

Where to not use hydrocortisone

Hydrocortisone should generally not be used inside the vagina or on the external genitalia, such as the penis or testicles, due to the risk of unwanted side effects. Using topical hydrocortisone products on the face is also potentially unsafe and should only be attempted if recommended by a doctor. 

Is it safe to put hydrocortisone on your face?

Hydrocortisone should only be used on the face if specifically recommended by a doctor because it can worsen the symptoms of certain skin conditions, such as specific types of acne. Additionally, most hydrocortisone forms are unsafe to use in or around the eyes. However, some antibiotic eyedrops and eardrops contain small hydrocortisone that is safe for short-term use only. Significant side effects, including cataracts and glaucoma, may occur after repeated use of hydrocortisone-containing products in the eyes. Also, hydrocortisone eardrops and creams do not meet the sterile standards necessary for an eye product. Because of this, using hydrocortisone ear drops in the eyes may lead to eye irritation or infection. 

Is hydrocortisone a steroid?

Hydrocortisone is a type of steroid known as a corticosteroid. Hydrocortisone is a manufactured version of a hormone, and that is what causes it to have its effects on the body. However, corticosteroids are very different from the anabolic (body-builder type) steroids we may think of when we hear the generic term "steroid." In men, the inappropriate use of anabolic steroids is associated with undesirable side effects such as irritability, breast growth, and infertility. Women who use anabolic steroids may experience unwanted facial hair growth, male-patterned baldness, anger, and a deeper voice. While these are common side effects of anabolic steroids, they are not associated with corticosteroid use. When used topically (on the skin), very little hydrocortisone is absorbed through the skin and into the bloodstream, which means that hydrocortisone applied topically will target the area where directly applied and will generally not cause effects throughout the whole body. 

What are the side effects of hydrocortisone?

Common side effects of topical and rectal hydrocortisone include:

• Burning or stinging.
• Dryness of the area.
• Redness of the site.
• Acne.
• Tingling of the skin.

In some cases, hydrocortisone may cause or worsen skin irritation. Using topical hydrocortisone for extended periods may result in weaker skin, pigmented spots, and stretch marks. Common side effects of oral hydrocortisone include upset stomach, restlessness or trouble sleeping, sweating, loss of appetite, and weight gain.

Can you use hydrocortisone when pregnant?

Hydrocortisone has not been extensively studied in pregnant women. In animal studies, using hydrocortisone during pregnancy was associated with fetal harm. Because of this, hydrocortisone and other corticosteroids are often not recommended for use by pregnant women.

What should I do if I use too much hydrocortisone or use it by accident?

If you experience unexpected or unwanted effects after using hydrocortisone, use it by mistake, or think you have used too much, get guidance from Poison Control immediately. Help from Poison Control is available online at www.poison.org and by phone at 1-800-222-1222. Both options are free, confidential, and available 24 hours a day.

Sierra Jaramillo, BS, PharmD Candidate 2023
Student Pharmacist, Pharmacist Intern