1. Clinical Overview
Hydrocortisone 1% w/w is a topical corticosteroid preparation of low to moderate potency. It is the pharmaceutical equivalent of the endogenous glucocorticoid cortisol (hydrocortisone). It exerts potent anti-inflammatory, anti-pruritic, and vasoconstrictive effects by modulating gene expression. In the Indian context, it is a first-line, widely available, and cost-effective topical steroid for managing mild to moderate inflammatory dermatoses.
| Onset | Duration | Bioavailability |
|---|---|---|
| Anti-pruritic effects may be noticed within a few hours. Significant anti-inflammatory effects are typically observed within 24 to 48 hours of application. | Approximately 8 to 12 hours per application, necessitating application 2-3 times daily as prescribed. | Topical bioavailability is variable (1-5%) depending on the vehicle (cream, ointment, lotion), skin integrity, site of application, and use of occlusive dressings. Systemic absorption is minimal when used on intact skin for limited duration and surface area. |
2. Mechanism of Action
Hydrocortisone diffuses across cell membranes and binds with high affinity to specific cytoplasmic glucocorticoid receptors. The activated receptor-ligand complex translocates to the nucleus, where it binds to glucocorticoid response elements (GREs) on DNA, modulating the transcription of specific target genes. This leads to the synthesis of anti-inflammatory proteins (lipocortin-1) and inhibition of the synthesis of pro-inflammatory mediators.
3. Indications & Uses
- Mild to moderate atopic dermatitis (eczema)
- Contact dermatitis (allergic and irritant)
- Seborrheic dermatitis
- Intertrigo
- Mild psoriasis (excluding plaque psoriasis)
- Insect bite reactions
- Sunburn (for inflammation)
4. Dosage & Administration
Adult Dosage: Apply a thin film to the affected area 2 to 3 times daily. Treatment should be limited to 7-14 days. Maximum weekly dose should not exceed 50 grams for an adult.
Administration: 1. Wash and dry hands and affected area. 2. Apply a pea-sized amount (approx. 0.5g) to cover an area the size of an adult palm. 3. Gently rub in until absorbed. 4. Do not cover with tight bandages or occlusive dressings unless specifically directed by a physician. 5. Avoid contact with eyes, mouth, nose, and mucous membranes. 6. Wash hands after application unless hands are the treated area.
5. Side Effects
Common side effects may include:
- Mild, transient burning or stinging at application site
- Dryness of skin
- Itching (pruritus)
- Skin irritation
- Folliculitis
6. Drug Interactions
| Drug | Effect | Severity |
|---|---|---|
| Other Topical Corticosteroids (e.g., Clobetasol, Betamethasone) | Additive risk of local and systemic side effects, including skin atrophy and adrenal suppression. | Major |
| Topical Immunosuppressants (e.g., Tacrolimus, Pimecrolimus) | May be used sequentially but concurrent use not typically recommended; consult dermatologist. | Moderate |
| Topical Antifungals (e.g., Clotrimazole, Miconazole) or Antibacterials (e.g., Mupirocin, Fusidic Acid) | Often used in combination for infected dermatoses. No significant PK interaction. | Minor |
| Systemic CYP3A4 Inhibitors (e.g., Ketoconazole, Itraconazole, Clarithromycin, Ritonavir) | May inhibit the metabolism of systemically absorbed hydrocortisone, increasing the risk of systemic effects. | Moderate |
7. Patient Counselling
- DO use only on the skin as directed.
- DO apply a thin layer only.
- DO wash hands before and after application (unless hands are treated).
- DO use for the full prescribed time, but do not use longer.
- DON'T use on broken or infected skin unless directed by a doctor.
- DON'T cover the treated area with bandages or plastic wraps unless told to do so.
- DON'T use on the face, groin, or underarms for more than 1 week unless directed.
- DON'T get it in your eyes, nose, or mouth.
8. Toxicology & Storage
Overdose: Topical Overdose: Extended use can lead to skin atrophy, striae, telangiectasia, HPA axis suppression, Cushingoid features (moon face, central obesity), hyperglycemia, and increased susceptibility to infection. Acute Ingestion: Oral ingestion of topical cream is unlikely to cause acute toxicity due to low amount of active drug per tube, but may cause GI upset.
Storage: Store at room temperature (15-25°C). Protect from light, heat, and freezing. Keep the tube tightly closed. Keep out of reach and sight of children. Do not flush medications down the toilet or pour them into drainage. Dispose of unused medicine as per local regulations.