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 body to block certain immune reactions that cause itching and inflammation (swelling). Hydrocortisone is available in multiple forms, including topical creams and ointments, oral tablets, and rectal creams and suppositories. The topical creams come in over-the-counter and prescription strengths, while the oral medications are only available by prescription. 

What is hydrocortisone cream used for?

The U.S. Food and Drug Administration (FDA) has approved topical hydrocortisone for treating dermatitis and other skin conditions that cause itching, such as bug bites and psoriasis. Hydrocortisone can also be used to treat sunburn, redness of the skin, 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 (inflammation 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 side effects. 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 some types of acne. Additionally, most hydrocortisone products are unsafe to use in or around the eyes. However, some antibiotic eyedrops and eardrops contain small amounts of hydrocortisone that are safe for short-term use only. Side effects, including cataracts and glaucoma, can 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 could lead to eye irritation or infection.

Is hydrocortisone a steroid?

Hydrocortisone is a type of steroid known as a corticosteroid and is a manufactured version of a hormone. Corticosteroids are very different from the anabolic (body-builder type) steroids we often think of when we hear the term "steroid." In men, the inappropriate use of anabolic steroids is associated with side effects such as irritability, breast growth, and infertility. Women who use anabolic steroids can experience unwanted facial hair growth, male-pattern 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 into the bloodstream, which means that hydrocortisone applied topically will target the area where it is directly applied and will generally not cause effects throughout the 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 can cause or worsen skin irritation. Using topical hydrocortisone for extended periods can 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
Student Pharmacist, Pharmacist Intern