Version October 2024
Dosage guidance:
Clinical considerations: The potency classifications of topical hydrocortisone products are provided in the table. In general, start with the lowest-potency agent appropriate for the condition severity and application site. Vehicle, concentration, site of application, use of occlusive dressings, and other factors can alter potency. Optimal response depends on choosing a vehicle that is appropriate for body location, lesion characteristics, and patient preference.
|
Hydrocortisone |
Vehicle |
Strength |
Potency (According to the US Classification System) |
|---|---|---|---|
|
a Goldstein 2021; Tadicherla 2009. | |||
|
Valerate |
Ointment |
0.2% |
Medium (group 4) |
|
Butyrate |
Cream, Lotion, Ointment, Solution |
0.1% |
Lower-mid (group 5) |
|
Probutate |
Cream |
0.1% |
Lower-mid (group 5) |
|
Valerate |
Cream |
0.2% |
Lower-mid (group 5) |
|
Acetate |
Cream, Lotion |
1%, 2%, 2.5% |
Least potent (group 7) |
|
Base |
Cream, Gel, Lotion, Ointment, Solution, Spray |
0.5%, 1%, 2%, 2.5% |
Least potent (group 7) |
Anal pruritus (pruritus ani), external (irritant-associated or idiopathic) (adjunct): Note: Use with conservative measures (eg, keeping area clean and dry, removal of offending agents) in patients with significant pruritus. An evaluation for the underlying cause of anal pruritus is essential, as the etiology may be due to an infectious, neoplastic, systemic, or other disease requiring definitive management (Ref).
Hydrocortisone 1% (cream, ointment [base]): Topical: Apply to affected anal area twice daily for up to 2 weeks in conjunction with a barrier cream (eg, zinc oxide); due to risk of skin atrophy, do not use hydrocortisone for >2 weeks (Ref).
Atopic dermatitis (eczema): Note: Concurrent use of emollients (applied liberally) is recommended (Ref). In the management of corticosteroid-responsive dermatoses, lower-potency agents are often preferred for sites at increased risk for corticosteroid-induced skin atrophy (eg, face, intertriginous areas). However, use of higher-potency agents in these areas can be appropriate for certain indications when prescribed under the guidance of a dermatologist. See “Clinical Considerations” at the top of the Dosing field for potency guidance.
Mild disease: Hydrocortisone 2.5% (cream, ointment [base, acetate]), 0.1% (cream, lotion, ointment [butyrate, probutate]), or 0.2% (cream [valerate]): Topical: Apply once or twice daily to affected areas for 2 to 4 weeks (Ref).
Moderate to severe disease: Hydrocortisone 0.2% (ointment [valerate]): Topical: Apply once or twice daily to affected areas for 2 to 4 weeks (Ref); in patients with improvement, maintenance therapy is suggested with an intermittent application once daily for 2 consecutive days per week (eg, weekends) or 2 to 3 times per week to previously affected areas for up to 16 weeks. Note: For areas affecting the face, groin, or other areas with skin folds, lower-potency preparations are generally recommended (unless limited to short-term use [5 to 7 days] and then switched to lower potency) (Ref).
Duration of therapy: Topical corticosteroids are generally well tolerated when used appropriately. Treatment courses of ∼2 weeks are common for certain chronic skin conditions; however, longer or repeated intermittent courses can be appropriate, particularly when prescribed under the guidance of a dermatologist. Conversely, a shorter course may be sufficient depending upon response and when used for minor self-limiting skin conditions (Ref).
Contact dermatitis: Note: If condition does not show prompt improvement (eg, within 1 to 2 weeks), reassess diagnosis and choice of treatment; consider evaluation by an experienced specialist (Ref). In the management of corticosteroid-responsive dermatoses, lower-potency agents are often preferred for sites at increased risk for corticosteroid-induced skin atrophy (eg, face, intertriginous areas). However, use of higher-potency agents in these areas can be appropriate for certain indications when prescribed under the guidance of a dermatologist. If hands, feet, or nonflexural areas are involved, higher-potency topical corticosteroids (not hydrocortisone) are recommended. See “Clinical Considerations” at the top of the Dosing field for potency guidance.
Allergic contact dermatitis (localized), mild to moderate:
Face and/or flexural areas: Hydrocortisone 0.1% (cream, lotion, ointment [butyrate, probutate]) or 0.2% (cream, ointment [valerate]): Topical: Apply once or twice daily to affected areas for 1 to 2 weeks; thereafter, may consider tapering (eg, with every-other-day application) over the subsequent 2 weeks (Ref).
Irritant contact dermatitis (localized), mild to moderate, acute or chronic: Note: In general, ointments are the preferred vehicle.
Face and/or flexural areas: Hydrocortisone 0.1% (cream, lotion, ointment [butyrate, probutate]) or 0.2% (cream, ointment [valerate]): Topical: Apply once or twice daily to affected areas for 1 to 2 weeks; thereafter, may consider tapering (eg, with every-other-day application) over the subsequent 2 weeks (Ref).
Duration of therapy: Topical corticosteroids are generally well tolerated when used appropriately. Treatment courses of ∼2 weeks are common for certain chronic skin conditions; however, longer or repeated intermittent courses can be appropriate, particularly when prescribed under the guidance of a dermatologist. Conversely, a shorter course may be sufficient depending upon response and when used for minor self-limiting skin conditions (Ref).
Genital pruritus, external (due to dermatitis) (adjunct): Note: Use with conservative measures (eg, keeping area clean and dry, removal of offending agents). An evaluation for the underlying cause is essential as the etiology may be due to an infectious, neoplastic, systemic, or other process requiring definitive management (Ref).
Balanitis: Hydrocortisone 1% (cream, ointment [base]): Topical: Apply to affected area twice daily for 1 to 2 weeks (Ref).
Vulvar dermatitis, mild: Hydrocortisone 0.5% to 2.5% (ointment [base]), 0.1% (ointment [butyrate]), or 0.2% (ointment [valerate]): Topical: Apply to affected area once daily for 2 to 4 weeks; therapy can be continued indefinitely at the minimum frequency for effective control of pruritus (goal <14 days per month). Ointments are preferred (Ref).
Hemorrhoids: Note: Use with conservative measures (eg, dietary modifications, warm sitz baths).
Rectal cream (preferred): Hydrocortisone 1% or 2.5%: Apply sparingly, up to twice daily; or
Rectal suppository: Insert 1 suppository (25 or 30 mg) twice daily.
Duration of therapy: Some experts recommend limiting use to ≤1 week due to risk of mucosal thinning (Ref).
Psoriasis, plaque (limited disease): Note: In the management of corticosteroid-responsive dermatoses, lower-potency agents are often preferred for sites at increased risk for corticosteroid-induced skin atrophy (eg, face, intertriginous areas). However, use of higher-potency agents in these areas can be appropriate for certain indications when prescribed under the guidance of a dermatologist. See “Clinical Considerations” at the top of the Dosing field for potency guidance.
Face and/or intertriginous areas: Hydrocortisone 1% to 2.5% (ointment, cream [base, acetate]): Topical: Apply twice daily until lesions resolve; a common treatment course is 2 weeks (Ref).
Duration of therapy: Topical corticosteroids are generally well tolerated when used appropriately. Treatment courses of ∼2 weeks are common for certain chronic skin conditions; however, longer or repeated intermittent courses can be appropriate, particularly when prescribed under the guidance of a dermatologist. Conversely, a shorter course may be sufficient depending upon response and when used for minor self-limiting skin conditions (Ref).
Seborrheic dermatitis: Note: Administer alone or in combination with a topical antifungal. In the management of corticosteroid-responsive dermatoses, lower-potency agents are often preferred for sites at increased risk for corticosteroid-induced skin atrophy (eg, face, intertriginous areas). However, use of higher-potency agents in these areas can be appropriate for certain indications when prescribed under the guidance of a dermatologist. See “Clinical Considerations” at the top of the Dosing field for potency guidance.
Face and/or intertriginous areas: Hydrocortisone 1% to 2.5% (cream, gel, lotion, ointment [base, acetate]): Topical: Apply once or twice daily until symptoms subside (usually 1 to 2 weeks) (Ref).
Chest or upper back: Hydrocortisone 0.2% (cream, ointment [valerate]): Topical: Apply once or twice daily until symptoms subside (usually 1 to 2 weeks) (Ref).
Duration of therapy: Topical corticosteroids are generally well tolerated when used appropriately. Treatment courses of ∼2 weeks are common for certain chronic skin conditions; however, longer or repeated intermittent courses can be appropriate, particularly when prescribed under the guidance of a dermatologist. Conversely, a shorter course may be sufficient depending upon response and when used for minor self-limiting skin conditions (Ref).
Stasis dermatitis (off-label use): Note: In the management of corticosteroid-responsive dermatoses, lower-potency agents are often preferred for sites at increased risk for corticosteroid-induced skin atrophy (eg, face, intertriginous areas). However, use of higher-potency agents in these areas can be appropriate for certain indications when prescribed under the guidance of a dermatologist. See “Clinical Considerations” at the top of the Dosing field for potency guidance.
Hydrocortisone 0.2% (ointment [valerate]): Topical: Apply once or twice daily for 1 to 2 weeks; due to risk of skin atrophy and ulceration, avoid prolonged use (Ref).
Duration of therapy: Topical corticosteroids are generally well tolerated when used appropriately. Treatment courses of ∼2 weeks are common for certain chronic skin conditions; however, longer or repeated intermittent courses can be appropriate, particularly when prescribed under the guidance of a dermatologist. Conversely, a shorter course may be sufficient depending upon response and when used for minor self-limiting skin conditions (Ref).
Ulcerative colitis, distal, mild to moderately active (alternative agent ):
Induction of remission:
Rectal suppository: 1 suppository (25 or 30 mg) once daily; if symptoms (eg, diarrhea, bleeding) persist after 2 weeks, may increase to 1 suppository twice daily for up to 4 weeks, followed by once daily dosing for up to 2 additional weeks (Ref). Note: In patients with proctosigmoiditis (eg, >18 cm involvement), suppositories may be used concurrently with either the rectal foam or enemas as part of a twice daily regimen (Ref).
Rectal foam: 1 applicatorful (90 mg) once daily; in patients with proctosigmoiditis (eg, >18 cm involvement) who have persistent symptoms (eg, diarrhea, bleeding) after 2 weeks of once daily dosing, may increase to 1 applicatorful (90 mg) twice daily for up to 4 weeks followed by once daily dosing for up to 2 additional weeks (Ref).
Rectal enema: 1 enema (100 mg/60 mL unit) once daily; in patients with proctosigmoiditis (eg, >18 cm involvement) who have persistent symptoms (eg, diarrhea, bleeding) after 2 weeks of once daily dosing, some experts increase to 1 enema (100 mg/60 mL unit) twice daily for up to 4 weeks, followed by once daily dosing for up to 2 additional weeks (Ref).
Duration of therapy: Usually 3 to 4 weeks; avoid use for >8 weeks due to risks associated with long-term topical glucocorticoid use (Ref).
Vaginitis, desquamative inflammatory (off-label use): Note: An evaluation by an experienced clinician is generally required.
Hydrocortisone 10% cream (10% strength is not commercially available; must be prepared by a licensed compounding facility): Intravaginal: Insert 3 to 5 g intravaginally (via a vaginal applicator) once daily, usually at bedtime; duration of therapy is typically 4 to 6 weeks. Note: For mild disease, particularly if hydrocortisone 10% cream is not available, may consider inserting hydrocortisone 0.5% cream (base) or 1 rectal suppository (25 mg [acetate]) intravaginally twice daily (Ref).
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
Refer to adult dosing.
(For additional information see "Hydrocortisone (topical): Pediatric drug information")
Atopic dermatitis: Infants ≥3 months, Children, and Adolescents: Hydrocortisone butyrate (Locoid Lipocream, Locoid lotion): Topical: Apply a thin film to affected area twice daily; if no improvement within 2 weeks, reassess diagnosis.
Corticosteroid-responsive dermatoses (including psoriasis): Infants, Children, and Adolescents: Hydrocortisone base (cream, ointment), hydrocortisone acetate (2% lotion): Topical: Apply a thin film to affected area 2 to 4 times daily depending on the severity of the condition; may use occlusive dressings to manage psoriasis or recalcitrant conditions
Dermatologic irritation, minor: OTC Labeling: Children ≥2 years and Adolescents: Hydrocortisone base: Topical: Apply to affected area up to 3 to 4 times daily
Anal and genital itching, external: OTC labeling: Children ≥12 years and Adolescents: Hydrocortisone base: Topical: Apply to affected area up to 3 to 4 times daily
Ulcerative colitis, mild to moderate (induction): Limited data available (Ref): Children and Adolescents: Rectal enema/suspension: Rectal: One enema (100 mg) once or twice daily (Ref). Once daily administration in the evening for 3 weeks was used in 52 adolescent and adult patients (age range: 16 to 67 years) in a randomized, double blind study comparing hydrocortisone enemas to rectal suspension of 5-aminosalicylic acid (Ref)
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
The following adverse drug reactions are derived from product labeling unless otherwise specified. Local adverse events presented. Adverse events similar to those observed with systemic absorption are also observed, especially following rectal use. Refer to the Hydrocortisone (Systemic) monograph for details.
Frequency not defined:
Cream, ointment: Dermatologic: Acneiform eruption, atrophic striae, burning sensation of skin, folliculitis, hypertrichosis, hypopigmentation, maceration of the skin, miliaria, perioral dermatitis, pruritus, secondary skin infection, skin atrophy, skin irritation, xeroderma
Lotion:
Dermatologic: Acne vulgaris (infantile acne), eczema, skin depigmentation
Local: Application-site reaction (including application-site burning, application-site dermatitis, application-site erythema, application-site irritation, application-site pruritus, local inflammation)
Enema:
Gastrointestinal: Rectal hemorrhage
Local: Local pain, localized burning
Suppositories:
Dermatologic: Allergic contact dermatitis, folliculitis, hypopigmentation, pruritus, xeroderma
Infection: Secondary infection
Local: Localized burning
Hypersensitivity to hydrocortisone or any component of the formulation; systemic fungal infections and ileocolostomy during the immediate or early postoperative period (rectal suspension); obstruction, abscess, perforation, peritonitis, fresh intestinal anastomoses, extensive fistulas, and sinus tracts (rectal foam).
OTC labeling: When used for self-medication, do not use for the treatment of diaper dermatitis.
Concerns related to adverse effects:
• Adrenal suppression: May cause hypercortisolism or suppression of hypothalamic-pituitary-adrenal (HPA) axis, particularly in younger children or in patients receiving high doses for prolonged periods. HPA axis suppression may lead to adrenal crisis.
• Anaphylactoid reactions: Rare cases of anaphylactoid reactions have been observed in patients receiving corticosteroids.
• Contact dermatitis: Allergic contact dermatitis can occur and is usually diagnosed by failure to heal rather than clinical exacerbation; discontinue use if irritation occurs and treat appropriately.
• Immunosuppression: Prolonged use of corticosteroids may increase the incidence of secondary infection, mask acute infection (including fungal infections), prolong or exacerbate viral infections, or limit response to vaccines. Exposure to chickenpox or measles should be avoided; corticosteroids should not be used to treat ocular herpes simplex. Corticosteroids should not be used for cerebral malaria, fungal infections, or viral hepatitis. Close observation is required in patients with tuberculosis (TB) infection (latent TB) and/or tuberculosis reactivity; restrict use in TB disease (active TB) (only fulminating or disseminated tuberculosis in conjunction with antituberculosis treatment). Amebiasis should be ruled out in any patient with recent travel to tropical climates or unexplained diarrhea prior to initiation of corticosteroids.
• Kaposi sarcoma: Prolonged treatment with corticosteroids has been associated with the development of Kaposi sarcoma (case reports); if noted, discontinuation of therapy should be considered (Goedert 2002).
• Myopathy: Acute myopathy has been reported with high-dose corticosteroids, usually in patients with neuromuscular transmission disorders; may involve ocular and/or respiratory muscles; monitor creatine kinase; recovery may be delayed.
• Psychiatric disturbances: Corticosteroid use may cause psychiatric disturbances, including depression, euphoria, insomnia, mood swings, and personality changes. Preexisting psychiatric conditions may be exacerbated by corticosteroid use.
• Sensitization: Topical use has been associated with local sensitization (redness, irritation); discontinue if sensitization is noted.
• Systemic effects: Topical corticosteroids may be absorbed percutaneously. Absorption of topical corticosteroids may cause manifestations of Cushing syndrome, hyperglycemia, or glycosuria. Absorption is increased by the use of occlusive dressings, application to denuded skin, prolonged use, or application to large surface areas.
Disease-related concerns:
• Cardiovascular disease: Use with caution in patients with heart failure and/or hypertension.
• Diabetes: Use with caution in patients with diabetes mellitus.
• Gastrointestinal disease: Use with caution in patients with GI diseases (diverticulitis, intestinal anastomoses, peptic ulcer, nonspecific ulcerative colitis).
• Hepatic impairment: Use with caution in patients with hepatic impairment, including cirrhosis.
• Myasthenia gravis: Use with caution in patients with myasthenia gravis.
• Myocardial infarction: Use with caution following acute myocardial infarction (MI); corticosteroids have been associated with myocardial rupture.
• Ocular disease: Use with caution in patients with cataracts and/or glaucoma; increased intraocular pressure, glaucoma, and cataracts have occurred with prolonged use.
• Osteoporosis: Use with caution in patients with osteoporosis.
• Renal impairment: Use with caution in patients with renal impairment; fluid retention may occur.
• Thyroid disease: Use caution with thyroid disease. Changes in thyroid status may necessitate dosage adjustments; metabolic clearance of corticosteroids increases in hyperthyroid patients and decreases in hypothyroid ones.
• Ulcerative colitis: With severe ulcerative colitis, it may be hazardous to delay surgery while waiting for response to treatment.
Special populations:
• Older adult: Because of the risk of adverse effects associated with systemic absorption, topical corticosteroids should be used cautiously in elderly patients in the smallest possible effective dose for the shortest duration.
• Pediatric: Children may absorb proportionally larger amounts after topical application and may be more prone to systemic effects. HPA axis suppression, intracranial hypertension, and Cushing syndrome have been reported in children receiving topical corticosteroids. Prolonged use may affect growth velocity; growth should be routinely monitored in pediatric patients.
Dosage form specific issues:
• Appropriate use: Avoid use of topical preparations with occlusive dressings or on weeping or exudative lesions. Not for treatment of diaper dermatitis.
• Benzyl alcohol: Some dosage forms may contain benzyl alcohol and/or sodium benzoate/benzoic acid; benzoic acid (benzoate) is a metabolite of benzyl alcohol; large amounts of benzyl alcohol (≥99 mg/kg/day) have been associated with a potentially fatal toxicity (“gasping syndrome”) in neonates; the “gasping syndrome” consists of metabolic acidosis, respiratory distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension and cardiovascular collapse (AAP ["Inactive" 1997]; CDC 1982); some data suggests that benzoate displaces bilirubin from protein binding sites (Ahlfors 2001); avoid or use dosage forms containing benzyl alcohol and/or benzyl alcohol derivative with caution in neonates. See manufacturer's labeling.
• Rectal enema: Damage to the rectal wall may occur from improper or careless insertion of the enema tip. Use with caution when there is a probability of impending perforation, abscess, or other pyogenic infection; obstruction; or extensive fistulas and sinus tracts.
• Rectal foam: Do not insert any part of the aerosol container directly into the anus. Contents are under pressure; do not burn or puncture the container; do not store at temperatures above 48.9°C (120°F). If there is not evidence of clinical or proctologic improvement within 2 or 3 weeks after initiation of therapy, or if the condition worsens, discontinue use. Contraindicated in obstruction, abscess, perforation, peritonitis, fresh intestinal anastomoses, extensive fistulas, and sinus tracts.
Other warnings/precautions:
• Discontinuation of therapy: After long-term use, withdraw therapy with gradual tapering of dose.
• Self-medication (OTC use): Contact health care provider if condition worsens, symptoms persist for >7 days, or rectal bleeding occurs.
• Stress: May require higher doses when subject to stress (ie, trauma, surgery, severe infection).
The extent of percutaneous absorption is dependent on several factors, including epidermal integrity (intact vs abraded skin), formulation, age of the patient, prolonged duration of use, and the use of occlusive dressings. Percutaneous absorption of topical steroids is increased in neonates (especially preterm neonates), infants, and young children. Infants and small children may be more susceptible to HPA axis suppression, intracranial hypertension, Cushing syndrome, or other systemic toxicities due to larger skin surface area to body mass ratio.
Some dosage forms may contain propylene glycol; in neonates large amounts of propylene glycol delivered orally, intravenously (eg, >3,000 mg/day), or topically have been associated with potentially fatal toxicities which can include metabolic acidosis, seizures, renal failure, and CNS depression; toxicities have also been reported in children and adults including hyperosmolality, lactic acidosis, seizures and respiratory depression; use caution (AAP 1997; Shehab 2009).
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Cream, External:
Hydroxym: 2% (28 g) [contains cetyl alcohol, edetate (edta) trisodium]
Cream, External, as acetate [strength expressed as base]:
Vanicream HC Maximum Strength: 1% (57 g) [dye free, formaldehyde free, fragrance free, lanolin free, paraben free; contains cetearyl alcohol]
Cream, External, as base:
Ala-Cort: 1% (28.4 g); 2.5% (30 g [DSC]) [contains cetyl alcohol, propylene glycol]
Anusol-HC: 2.5% (30 g)
Cortaid Maximum Strength: 1% (28 g [DSC]) [contains cetyl alcohol, disodium edta, ethylparaben, methylparaben, propylparaben]
Curad Hydrocortisone: 1% (1.5 g [DSC], 28.4 g [DSC]) [latex free; contains methylparaben, polysorbate 80, propylene glycol, propylparaben]
FT Itch Relief Max Strength: 1% (28.4 g) [contains cetyl alcohol, methylparaben, propylene glycol, propylparaben]
FT Itch Relief/Aloe Max Str: 1% (28.4 g, 60 g) [contains cetyl alcohol, methylparaben, propylparaben]
Hydrocortisone Anti-Itch: 1% (1 ea) [contains cetyl alcohol]
Hydrocortisone Anti-Itch: 1% (28 g) [contains cetyl alcohol, chlorocresol (chloro-m-cresol), propylene glycol]
Hydrocortisone Max St: 1% (28.4 g)
Hydrocortisone Max St: 1% (28 g [DSC]) [contains cetyl alcohol, methylparaben, propylene glycol, propylparaben]
Hydrocortisone Max St/12 Moist: 1% (28.4 g) [contains cetearyl alcohol, methylparaben, propylene glycol, propylparaben]
Hydrocortisone/Aloe Max Str: 1% (28 g) [contains cetyl alcohol, edetate (edta) trisodium, isopropyl alcohol, methylparaben, propylparaben, trolamine (triethanolamine)]
Hydrocortisone/Aloe Max Str: 1% (28 g [DSC]) [contains cetyl alcohol, methylparaben, propylene glycol, propylparaben]
Instacort 5: 0.5% (28.4 g)
Medpura Hydrocortisone: 1% (28 g [DSC]) [contains benzyl alcohol, cetyl alcohol]
Preparation H: 1% (26 g) [contains cetyl alcohol, edetate (edta) disodium, methylparaben, propylene glycol, propylparaben, sodium benzoate]
Procto-Med HC: 2.5% (28 g, 30 g) [contains cetearyl alcohol, methylparaben, propylene glycol, propylparaben]
Procto-Pak: 1% (28.4 g [DSC])
Proctocort: 1% (28.4 g) [contains cetyl alcohol, propylene glycol]
Proctosol HC: 2.5% (28.35 g)
Proctozone-HC: 2.5% (30 g [DSC])
Proctozone-HC: 2.5% (30 g) [contains cetearyl alcohol, methylparaben, propylene glycol, propylparaben]
Generic: 0.5% (15 g, 28.35 g [DSC], 28.4 g); 1% (1 ea, 1 g [DSC], 14.2 g, 20 g [DSC], 28 g, 28.35 g, 28.4 g, 30 g, 453.6 g, 454 g); 2.5% (20 g, 28 g, 28.35 g, 30 g, 453.6 g, 454 g)
Cream, External, as butyrate:
Locoid: 0.1% (15 g [DSC], 45 g [DSC]) [contains butylparaben, propylparaben]
Locoid Lipocream: 0.1% (45 g, 60 g [DSC]) [contains butylparaben, cetostearyl alcohol, propylparaben]
Generic: 0.1% (15 g, 45 g, 60 g [DSC])
Cream, External, as probutate:
Pandel: 0.1% (80 g) [contains butylparaben, methylparaben, propylene glycol]
Cream, External, as valerate:
Generic: 0.2% (15 g, 45 g, 60 g)
Enema, Rectal, as base:
Colocort: 100 mg/60 mL (60 mL [DSC])
Cortenema: 100 mg/60 mL (60 mL) [contains methylparaben, polysorbate 80]
Generic: 100 mg/60 mL (60 mL)
Foam, External, as acetate:
Cortifoam: 10% [90 mg/applicatorful] (15 g) [contains cetyl alcohol, methylparaben, propylene glycol, propylparaben, trolamine (triethanolamine)]
Gel, External:
Hydroxate: 2% (28 g) [contains propylene glycol]
Hydroxym: 2% (28 g) [contains methylparaben, propylene glycol, propylparaben]
Kit, External, as base:
Advanced Allergy Collection: 2.5% [contains cetyl alcohol, methylparaben, propylene glycol, propylparaben]
Hydrocort Lotion Complete Kit: 2% [contains benzalkonium chloride, isopropyl alcohol, menthol, methylparaben, propylene glycol, propylparaben]
Scalacort DK: Hydrocortisone lotion 2% and Sal Acid 2% and sulfur 2% [contains benzalkonium chloride, isopropyl alcohol, methylparaben, propylene glycol, propylparaben, soybean lecithin]
Lotion, External, as acetate:
NuCort: 2% (60 g) [contains benzyl alcohol, cetyl alcohol, menthol, trolamine (triethanolamine)]
Lotion, External, as base:
Ala Scalp: 2% (29.6 mL, 59.2 mL) [contains benzalkonium chloride, isopropyl alcohol, propylene glycol]
Aquanil HC: 1% (120 mL)
Beta HC: 1% (60 mL)
Sarnol-HC: 1% (59 mL)
Generic: 1% (114 g, 120 mL); 2.5% (59 mL, 118 mL)
Lotion, External, as butyrate:
Locoid: 0.1% (59 mL, 118 mL) [contains butylparaben, cetostearyl alcohol, propylparaben]
Generic: 0.1% (59 mL, 118 mL)
Ointment, External, as acetate:
Generic: 1% (28.4 g, 30 g)
Ointment, External, as base:
FT Itch Relief Max Strength: 1% (28.4 g) [contains coconut oil (copra/cocos nucifera oil), methylparaben, propylparaben]
Hydrocortisone Max St: 1% (28 g [DSC])
Generic: 0.5% (28 g [DSC], 30 g); 2.5% (20 g, 28.35 g, 453.6 g, 454 g); 1% (28 g, 28.35 g, 28.4 g, 30 g, 453.6 g)
Ointment, External, as butyrate:
Generic: 0.1% (15 g, 45 g)
Ointment, External, as valerate:
Generic: 0.2% (15 g, 45 g, 60 g)
Solution, External, as base:
Scalpicin Maximum Strength: 1% (44 mL [DSC]) [contains disodium edta, menthol, propylene glycol]
Texacort: 2.5% (30 mL) [lipid free, paraben free; contains alcohol, usp]
Solution, External, as butyrate:
Locoid: 0.1% (60 mL [DSC]) [contains isopropyl alcohol]
Generic: 0.1% (20 mL, 60 mL)
Suppository, Rectal, as acetate:
Anucort-HC: 25 mg (1 ea, 12 ea, 24 ea, 100 ea)
Anusol-HC: 25 mg (12 ea, 24 ea)
Hemmorex-HC: 25 mg (12 ea, 24 ea); 30 mg (12 ea)
Proctocort: 30 mg (12 ea)
Generic: 25 mg (12 ea, 24 ea, 100 ea [DSC]); 30 mg (12 ea)
May be product dependent
Cream (Anusol-HC External)
2.5% (per gram): $6.58
Cream (Hydrocortisone (Perianal) External)
1% (per gram): $2.11
2.5% (per gram): $2.77
Cream (Hydrocortisone Butyrate External)
0.1% (per gram): $4.18
Cream (Hydrocortisone External)
0.5% (per gram): $0.17
1% (per gram): $0.04 - $0.23
2.5% (per gram): $0.25 - $0.42
Cream (Hydrocortisone Valerate External)
0.2% (per gram): $4.01
Cream (Hydroxym External)
2% (per gram): $70.71
Cream (Locoid Lipocream External)
0.1% (per gram): $1.67
Cream (Pandel External)
0.1% (per gram): $17.54
Cream (Preparation H External)
1% (per gram): $0.27
Cream (Procto-Med HC External)
2.5% (per gram): $3.00
Cream (Proctocort External)
1% (per gram): $25.89
Cream (Proctosol HC External)
2.5% (per gram): $3.08
Cream (Proctozone-HC External)
2.5% (per gram): $2.91
Cream (Vanicream HC Maximum Strength External)
1.12%(1% Base) (per gram): $0.12
Enema (Cortenema Rectal)
100 mg/60 mL (per mL): $0.52
Enema (Hydrocortisone Rectal)
100 mg/60 mL (per mL): $0.43 - $1.00
Foam (Cortifoam External)
10% (per gram): $35.09
Gel (Hydroxate External)
2% (per gram): $70.71
Gel (Hydroxym External)
2% (per gram): $51.71
Kit (Advanced Allergy Collection External)
2.5% (per each): $882.00
Kit (Scalacort DK External)
2 & 2-2% (per mL): $0.37
Lotion (Ala Scalp External)
2% (per mL): $18.60
Lotion (Aquanil HC External)
1% (per mL): $0.14
Lotion (Hydrocortisone Butyrate External)
0.1% (per mL): $8.18 - $9.63
Lotion (Hydrocortisone External)
1% (per gram): $0.06
1% (per mL): $0.05
2.5% (per mL): $0.88 - $0.91
Lotion (Locoid External)
0.1% (per mL): $10.71
Lotion (NuCort External)
2% (per gram): $5.00
Lotion (Sarnol-HC External)
1% (per mL): $0.17
Ointment (Hydrocortisone Acetate External)
1% (per gram): $0.14
Ointment (Hydrocortisone Butyrate External)
0.1% (per gram): $3.82 - $3.98
Ointment (Hydrocortisone External)
0.5% (per gram): $0.10
1% (per gram): $0.15 - $0.23
2.5% (per gram): $0.39
Ointment (Hydrocortisone Valerate External)
0.2% (per gram): $4.41
Solution (Hydrocortisone Butyrate External)
0.1% (per mL): $3.98
Solution (Texacort External)
2.5% (per mL): $8.17
Suppository (Anusol-HC Rectal)
25 mg (per each): $73.25
Suppository (Hemmorex-HC Rectal)
25 mg (per each): $22.65
30 mg (per each): $16.68
Suppository (Hydrocortisone Acetate Rectal)
25 mg (per each): $1.80 - $22.65
30 mg (per each): $11.58 - $17.21
Suppository (Proctocort Rectal)
30 mg (per each): $68.10
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Cream, External, as base:
Barriere-HC: 1% (45 g)
Emo Cort: 1% ([DSC]) [contains cetearyl alcohol]
Hyderm: 1% (15 g, 500 g)
Prevex HC: 1% ([DSC])
Generic: 1% (15 g, 450 g); 2.5% (45 g, 225 g)
Cream, External, as valerate:
Hydroval: 0.2% (15 g, 45 g, 60 g, 500 g) [contains methylparaben, propylene glycol]
Enema, Rectal, as base:
Cortenema: 1.7 mg/mL ([DSC]) [contains methylparaben, polysorbate 80]
Lotion, External, as base:
Emo Cort: 1% ([DSC])
Sarna HC: 1% (150 mL) [contains cetyl alcohol, edetate (edta) disodium, menthol]
Ointment, External, as base:
Cortoderm: 1% (15 g, 454 g) [contains methylparaben, propylparaben]
Ointment, External, as valerate:
Hydroval: 0.2% (15 g, 60 g) [contains methylparaben, propylene glycol]
Topical products: Cream, gel, lotion, ointment, solution, spray: In general, for optimal absorption, apply topical corticosteroids to moist skin immediately after bathing or after wet soaks. Occlusive dressings will also enhance drug absorption, often by a factor of 10 (Ref). Occlusive dressing may be used if instructed by a health care professional. Shake lotion well before use.
Rectal products:
Rectal foam: Shake vigorously for 5 to 10 seconds prior to use. Do not remove cap during use. Hold container upright to fill applicator. Gently insert applicator tip into anus. Only use applicator provided by manufacturer; do not insert any part of the aerosol container in the anus. Clean applicator after each use with warm water.
Rectal suppository: Remove foil from rectal suppository and insert pointed end first. Avoid handling unwrapped suppository for too long.
Rectal suspension: Shake bottle well. Remove protective sheath from applicator tip. Lie on left side with left leg extended and right leg flexed forward. Gently insert lubricated applicator tip into rectum, pointed slightly toward navel. Grasp bottle firmly and squeeze slowly to instill the medication. After administering, withdraw and discard the used unit. Remain in position for at least 30 minutes. Retain the enema all night if possible.
Dermal preparations: For external topical use only; avoid contact with the eyes. Shake lotion well before use. Apply a thin film to clean, dry skin and rub in gently. Do not apply to face, underarms, or groin unless directed by physician. Do not wrap or bandage affected area unless directed by physician. Do not apply to diaper areas because diapers or plastic pants may be occlusive.
Rectal:
Foam: Shake vigorously for 5 to 10 seconds prior to use. Do not remove cap during use. Hold container upright to fill applicator. Gently insert applicator tip into anus. Only use applicator provided by manufacturer; do not insert any part of the aerosol container in the anus. Clean applicator after each use with warm water.
Suppository: Remove foil from rectal suppository and insert pointed end first. Avoid handling unwrapped suppository for too long.
Enema/suspension: Shake bottle well. Remove protective sheath from applicator tip. Lie on left side with left leg extended and right leg flexed forward. Gently insert lubricated applicator tip into rectum, pointed slightly toward navel. Grasp bottle firmly and squeeze slowly to instill the medication. After administering, withdraw and discard the used unit. Remain in position for at least 30 minutes. Retain the enema all night if possible.
Anal and genital pruritus, external: Topical: Use in external genital and anal itching.
Corticosteroid-responsive dermatoses (eg, atopic dermatitis, contact dermatitis, vulvar dermatitis, psoriasis, seborrheic dermatitis): Topical: Relief of inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses.
Hemorrhoids: Rectal: Use in inflamed hemorrhoids.
Ulcerative colitis: Rectal: Treatment of ulcerative colitis, especially distal forms, including ulcerative proctitis, ulcerative proctosigmoiditis, and left-sided ulcerative colitis.
Stasis dermatitis; Vaginitis, desquamative inflammatory
Hydrocortisone may be confused with hydrocodone, hydroxychloroquine, hydrochlorothiazide
Anusol may be confused with Anusol-HC, Aplisol, Aquasol
Cortizone may be confused with cortisone
HCT (occasional abbreviation for hydrocortisone) is an error-prone abbreviation (mistaken as hydrochlorothiazide)
Hytone may be confused with Vytone
Proctocort may be confused with ProctoCream
KIDs List: Medium, high, and very high potency topical corticosteroids, when used in neonates and infants <1 year of age for diaper dermatitis, are identified on the Key Potentially Inappropriate Drugs in Pediatrics (KIDs) list; use should be avoided due to risk of adrenal suppression; systemic absorption is higher in pediatric patients than adults (strong recommendation; low quality of evidence) (PPA [Meyers 2020]).
Nutracort [multiple international markets] may be confused with Nitrocor brand name of nitroglycerin [Italy, Russia, and Venezuela]
Substrate of CYP3A4 (minor); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.
Calcipotriene: Hydrocortisone (Topical) may diminish the therapeutic effect of Calcipotriene. Management: Monitor for reduced calcipotriene efficacy if combined with hydrocortisone valerate. Consider separating the administration of these agents by 10 to 12 hours to minimize the risk of this potential interaction. Risk C: Monitor therapy
Topical corticosteroids may be used for the treatment of corticosteroid-responsive dermatosis, such as atopic dermatitis, in patients planning a pregnancy (Vestergaard 2019).
Rectal corticosteroids may be used for the treatment of ulcerative colitis. Corticosteroids do not decrease fertility in patients with inflammatory bowel disease (IBD) who wish to become pregnant; however, active IBD may decrease fertility; pregnancy should be planned after a 3- to 6-month remission (Mahadevan 2019).
Systemic bioavailability of topical corticosteroids is variable (integrity of skin, use of occlusion, etc) and may be further influenced by trimester of pregnancy (Chi 2017). In general, the use of topical corticosteroids is not associated with a significant risk of adverse pregnancy outcomes; however, there may be an increased risk of low birth-weight infants following maternal use of potent or very potent topical products, especially in high doses, although this risk is likely to be low (Andersson 2021; Chi 2015; Chi 2017).
When first-line treatments, such as emollients, are insufficient, topical corticosteroids may be used for the treatment of atopic dermatitis in pregnant patients (Vestergaard 2019). Topical corticosteroids are classified by potency; the medication and formulation (eg, cream, gel, salt form) contribute to the potency classification (Oakley 2021; Stacey 2021; Tadicherla 2009). In general, use of the least potent product in limited amounts is recommended during pregnancy. Mild to moderate potency corticosteroids are preferred; potent to very potent topical corticosteroids should only be used as alternative therapy in limited amounts under obstetrical care. Pregnant patients should avoid application of topical corticosteroids to areas with high percutaneous absorption (eg, armpit, skin folds, vulva) (Chi 2017), and caution should be used when applying to areas prone to striae formation (eg, abdomen, breast, thighs) (Vestergaard 2019).
Rectal corticosteroids may be used for the treatment of ulcerative colitis. Corticosteroids may be used as needed for disease flares in pregnant patients with inflammatory bowel disease; however, maintenance therapy should be avoided (Mahadevan 2019).
Conservative measures (eg, dietary modifications, warm sitz baths) are preferred for the treatment of hemorrhoids in pregnancy; adjunctive topical treatment may be helpful in some patients (De Schepper 2021; Gallo 2020).
It is not known if sufficient quantities of hydrocortisone are absorbed following topical administration to produce detectable amounts in breast milk; however, systemic corticosteroids are present in breast milk.
Topical corticosteroids are generally considered acceptable for use in patients who are breastfeeding (Butler 2014; WHO 2002). However, because topical agents can be transferred to a breastfeeding infant, clean treated areas at risk for direct skin-to-skin contact prior to breastfeeding. Apply to the smallest area for the shortest duration possible. Avoid application of topical corticosteroids to the nipple and areola area until breastfeeding ceases; hypertension was noted in a breastfed infant when a high potency topical corticosteroid was applied to the nipple (AAD-NPF [Elmets 2021]; Butler 2014; Leachman 2006). If needed, apply topical corticosteroids immediately after breastfeeding and then clean nipples prior to the next feeding (Vestergaard 2019).
Rectal corticosteroids may be used for the treatment of ulcerative colitis; standard doses would not be expected to suppress lactation (Mahadevan 2019).
Skin atrophy; hypothalamic pituitary axis suppression.
Topical corticosteroids have anti-inflammatory, antipruritic, and vasoconstrictive properties. May depress the formation, release, and activity of endogenous chemical mediators of inflammation (kinins, histamine, liposomal enzymes, prostaglandins) through the induction of phospholipase A2 inhibitory proteins (lipocortins) and sequential inhibition of the release of arachidonic acid. Hydrocortisone has low to intermediate range potency (dosage-form dependent).
Absorption: Topical corticosteroids are absorbed percutaneously. The extent is dependent on several factors, including epidermal integrity (intact vs abraded skin), formulation, and the use of occlusive dressings. Percutaneous absorption of topical steroids is increased in neonates (especially preterm neonates), infants, and young children. Rectal absorption is more substantial than most topical preparations; therefore, systemic effects are more common.
Metabolism: Hepatic
Excretion: Urine (major); bile
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