Drugs List

Therapeutic Indications

Uses

Dermatitis - contact
Eczema
Insect bites

Contraindications

None known

Precautions and Warnings

Children under 10 years
Breastfeeding
Pregnancy

Avoid contact with eyes
Avoid occlusive dressings
Do not apply to ano-genital areas
Do not apply to broken or denuded skin
Not to be applied to infected skin
Not to be applied to the face
Occlusive dressings can increase the likelihood of systemic absorption
Long term use may cause adrenal suppression
Discontinue if condition worsens
Discontinue if hypersensitivity reactions occur
Maximum treatment 7 days unless on doctor's advice
Advise patient residue on clothing/bedding may cause fire hazard
Contact doctor if no improvement occurs
Fire hazard: Keep away from naked flames and potential sources of ignition
Nappy may act as an occlusive dressing

Pregnancy and Lactation

Pregnancy

Use topical hydrocortisone acetate with caution during pregnancy.

Topical application of corticosteroids to pregnant animals can cause abnormalities of foetal development including cleft palate and intrauterine growth retardation. There may therefore be a very small risk of such effects in the human foetus but the relevance of this study has not been established in humans. Nevertheless, topical corticosteroids with the exception of very potent steroids can be used relatively safely in pregnancy.

It is recommended to avoid using large amounts and for long periods of time if possible.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14-17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

No information is available, at the time of writing, on the use of topical hydrocortisone acetate during breastfeeding.

Corticosteroids generally appear only in low levels in human breast milk and the levels achieved from systemic absorption of topical applications are likely to be minimal.

If applied to the breast area, the area should be washed and dried prior to breastfeeding and the preparation applied afterwards.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Acne (at application site)
Contact dermatitis
Exacerbation of infection
Hypersensitivity reactions
Hypertrichosis
Mild depigmentation and vellus hair
Striae (irreversible)
Thinning of skin

Presentation

Topical formulations containing hydrocortisone acetate

Drugs List

Therapeutic Indications

Uses

Dermatitis - contact
Eczema
Insect bites

Dosage

Adults

Elderly

Children

Contraindications

None known

Precautions and Warnings

Children under 10 years
Breastfeeding
Pregnancy

Avoid contact with eyes
Avoid occlusive dressings
Do not apply to ano-genital areas
Do not apply to broken or denuded skin
Not to be applied to infected skin
Not to be applied to the face
Occlusive dressings can increase the likelihood of systemic absorption
Long term use may cause adrenal suppression
Discontinue if condition worsens
Discontinue if hypersensitivity reactions occur
Maximum treatment 7 days unless on doctor's advice
Advise patient residue on clothing/bedding may cause fire hazard
Contact doctor if no improvement occurs
Fire hazard: Keep away from naked flames and potential sources of ignition
Nappy may act as an occlusive dressing

Pregnancy and Lactation

Pregnancy

Use topical hydrocortisone acetate with caution during pregnancy.

Topical application of corticosteroids to pregnant animals can cause abnormalities of foetal development including cleft palate and intrauterine growth retardation. There may therefore be a very small risk of such effects in the human foetus but the relevance of this study has not been established in humans. Nevertheless, topical corticosteroids with the exception of very potent steroids can be used relatively safely in pregnancy.

It is recommended to avoid using large amounts and for long periods of time if possible.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14-17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

No information is available, at the time of writing, on the use of topical hydrocortisone acetate during breastfeeding.

Corticosteroids generally appear only in low levels in human breast milk and the levels achieved from systemic absorption of topical applications are likely to be minimal.

If applied to the breast area, the area should be washed and dried prior to breastfeeding and the preparation applied afterwards.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Acne (at application site)
Contact dermatitis
Exacerbation of infection
Hypersensitivity reactions
Hypertrichosis
Mild depigmentation and vellus hair
Striae (irreversible)
Thinning of skin

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Further Information

Last Full Review Date: May 2013

Reference Sources

British National Formulary, 65th Edition (March - September 2013) Pharmaceutical Press, London.

Summary of Product Characteristics: Hc45 Hydrocortisone Cream. Reckitt Benckiser Healthcare (UK) Ltd. Revised September 2012.
Summary of Product Characteristics: Lanacort ointment. Reckitt Benckiser Healthcare (UK) Ltd. Revised August 2011.