Hydrocortisone (Various generics (plain, unmodified hydrocortisone -- distinct from the valerate ester))

1. Health Canada Product Monograph — Hydrocortisone

• Topical therapy of corticosteroid-responsive dermatoses where anti-inflammatory, anti-allergic, or antipruritic activity is needed -- in psoriasis, this includes the face and skin folds (axillae, groin, inframammary area), where higher-potency agents carry an unacceptable risk of skin thinning with the more prolonged use these sites often need.
• Not for ophthalmic use.

• Should be used during pregnancy only if the potential benefit justifies the potential risk, particularly in the first trimester, and should not be used extensively, in large amounts, or for prolonged periods. Low-potency corticosteroids such as hydrocortisone are generally preferred over higher-potency agents when treatment is needed in pregnancy.
• Infants born to mothers who received substantial corticosteroid doses during pregnancy should be monitored for signs of low adrenal hormone function.

• Risk to a breastfeeding infant is considered low, since only extensive use of the most potent topical corticosteroids has been associated with detectable systemic transfer; avoid direct contact between a treated area and the infant's skin or mouth.

• No specific dosing differences are established; use the smallest effective amount for the shortest duration, with attention to skin thinning that can be more pronounced in aging skin.

• Safety and effectiveness in children have not been formally established for all strengths; children have a higher skin-surface-to-body-mass ratio than adults, increasing the risk of HPA-axis suppression, so use should be limited to the smallest effective amount for the shortest duration.

• Apply a thin layer to affected areas once or twice daily for a maximum of about 4 weeks.
• If the condition worsens or does not improve within 2 to 4 weeks, reassess the diagnosis and treatment plan.
• Avoid abrupt discontinuation once control is achieved, since rebound of the underlying dermatosis can occur; continue an emollient as maintenance therapy.
• Not for use under occlusive dressings unless specifically directed.

If overdose is suspected, seek emergency medical attention immediately or contact your regional Poison Control Centre without delay.

• Acute overdose from topical use is very unlikely. Chronic overuse can produce features of hypercortisolism; discontinue gradually rather than abruptly if this occurs.

• Application-site irritation, burning, stinging, or itching.
• Skin dryness.
• Folliculitis or mild acneiform eruptions.
• Mild, usually reversible skin lightening (hypopigmentation) at the application site.

Serious side effects require immediate discussion with the prescriber or emergency care.

• HPA-axis suppression and, rarely, Cushing's syndrome with prolonged, extensive use -- less likely at this potency than with moderate-to-ultra-high-potency agents, but still possible, especially in children or with use under occlusion.
• Skin atrophy, striae, and telangiectasia with prolonged use, particularly on the face or in skin folds.
• Allergic contact dermatitis to the product itself, usually recognized by a failure to heal rather than an obvious flare.
• In psoriasis specifically, reduction or discontinuation of topical corticosteroids has rarely been associated with a flare of pustular psoriasis.

• Use with caution on lesions close to the eyes -- accidental entry can raise intraocular pressure or contribute to glaucoma or cataract.
• Use with caution in patients with stasis dermatitis or other conditions with impaired circulation.
• If a skin infection is present or develops, use an appropriate antimicrobial agent and reassess if a symptomatic response is not seen within about a week.

• Hypersensitivity to hydrocortisone or any component of the formulation.
• Untreated bacterial, fungal, or viral skin infections (including herpes simplex, varicella, and vaccinia), cutaneous tuberculosis, and syphilitic skin lesions.
• Not for ophthalmic use.

• Co-administered strong CYP3A4 inhibitors (e.g., ritonavir, itraconazole) can theoretically increase systemic corticosteroid exposure, though this is of limited practical relevance for typical short-course topical use.
• Concurrent use of other corticosteroid-containing products (topical, inhaled, intranasal, or systemic) adds to total corticosteroid exposure.

• Not applicable -- this is a topical product, not taken by mouth.

• Apply once or twice daily; no relationship to meal timing.

• Store at controlled room temperature, out of reach of children.

• This is a mild-to-moderate strength topical corticosteroid cream or ointment, often used for delicate areas like the face and skin folds where stronger steroids are more likely to thin the skin.
• Apply a thin layer to the affected skin once or twice daily, generally for no more than about 4 weeks at a time.
• Common effects include mild burning, stinging, dryness, or irritation where it is applied.
• Contact your prescriber if the treated area is not improving within 2 to 4 weeks, or if you notice skin thinning or stretch marks with longer-term use.
• Tell your pharmacist or physician if you are pregnant, planning pregnancy, or breastfeeding.