Drugs List

Therapeutic Indications

Uses

Psoriasis excluding widespread plaque psoriasis
Scalp dermatoses responsive to topical corticosteroids
Skin conditions responsive to topical corticosteroids

Treatment of conditions responsive to topical corticosteroids including eczema, dermatitis and psoriasis (excluding widespread plaque psoriasis).
Hydrocortisone butyrate emulsion is suitable for moist, weeping and scaly lesions.
Hydrocortisone butyrate cream and ointment may be applied under occlusion in more resistant lesions.

Dosage

Apply a thin layer once or twice daily.

Contraindications

Children under 3 months
Acne vulgaris
Perioral dermatitis
Rosacea
Skin infection

Precautions and Warnings

Nappy rash
Breastfeeding
Pregnancy

Careful supervision of patients with psoriasis required
May mask symptoms or signs of infections
Not all available products are licensed for all uses
Some formulations contain cetostearyl alcohol
Some formulations contain hydroxybenzoate
Some formulations contain propylene glycol
Advise patient to wash hands after use
Application under occlusion should be restricted to limited areas
Avoid contact with eyes
May cause local and systemic toxicity especially in prolonged/extensive use
Not to be applied to the face
Occlusive dressings can increase the likelihood of systemic absorption
Paediatric patients may be more susceptible to systemic toxicity
Application to areas of thin skin may cause atrophy + increased absorption
Prolonged/excessive use may lead to adrenal suppression
Rebound effect may occur after cessation of treatment
Risk of generalised pustular psoriasis with use of topical corticosteroids
Avoid long-term use particularly in infants and children
Maximum duration of treatment 7 days in infants
Advise patient residue on clothing/bedding may cause fire hazard
Fire hazard: Keep away from naked flames and potential sources of ignition
Nappy may act as an occlusive dressing

Supervision is required if used in psoriasis as topical corticosteroids have the potential to be hazardous including rebound relapses following development of tolerance, risk of pustular psoriasis and developments of local and systemic toxicity due to impaired barrier function of the skin.

Hydrocortisone butyrate should not be applied to the eyelids due to the risk of glaucoma simplex or subcapsular cataract.

Pregnancy and Lactation

Pregnancy

Use hydrocortisone butyrate with caution in pregnancy.

At the time of writing there is limited published information regarding the use of hydrocortisone butyrate in human pregnancy. Animal studies have shown some reproductive toxicity and Schaefer (2015) categorise hydrocortisone butyrate as a moderately potent topical glucocorticosteroid. Briggs (2015) states hydrocortisone poses a small risk during pregnancy including dose related teratogenic effects, however the majority of evidence suggests corticosteroids are most likely the cause of those adverse effects. The potential benefit of using hydrocortisone butyrate during pregnancy most likely outweighs the potential risk to the foetus (Briggs et al, 2015).

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 to 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

Use hydrocortisone butyrate with caution in breastfeeding.

Hydrocortisone butyrate is excreted in breast milk. Hale (2014) categorises this topical steroid as an intermediate level of potency stating hydrocortisone butyrate is considered safe to use in breastfeeding when applying the minimal amount, however use with caution when applying to the nipple area.
The manufacturer states the therapeutic dose of hydrocortisone butyrate is unlikely to cause harm to the breastfed infant.

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
Adrenal suppression
Contact dermatitis
Cushing's syndrome
Exacerbation of acne
Exacerbation of infection
Hypersensitivity reactions
Hypertrichosis
Local atrophic changes
Perioral dermatitis
Skin depigmentation
Striae atrophicae (irreversible)
Telangiectasia
Thinning of skin
Worsening of rosacea

Presentation

Topical formulations of hydrocortisone butyrate

Drugs List

Therapeutic Indications

Uses

Psoriasis excluding widespread plaque psoriasis
Scalp dermatoses responsive to topical corticosteroids
Skin conditions responsive to topical corticosteroids

Treatment of conditions responsive to topical corticosteroids including eczema, dermatitis and psoriasis (excluding widespread plaque psoriasis).
Hydrocortisone butyrate emulsion is suitable for moist, weeping and scaly lesions.
Hydrocortisone butyrate cream and ointment may be applied under occlusion in more resistant lesions.

Dosage

Apply a thin layer once or twice daily.

Contraindications

Children under 3 months
Acne vulgaris
Perioral dermatitis
Rosacea
Skin infection

Precautions and Warnings

Nappy rash
Breastfeeding
Pregnancy

Careful supervision of patients with psoriasis required
May mask symptoms or signs of infections
Not all available products are licensed for all uses
Some formulations contain cetostearyl alcohol
Some formulations contain hydroxybenzoate
Some formulations contain propylene glycol
Advise patient to wash hands after use
Application under occlusion should be restricted to limited areas
Avoid contact with eyes
May cause local and systemic toxicity especially in prolonged/extensive use
Not to be applied to the face
Occlusive dressings can increase the likelihood of systemic absorption
Paediatric patients may be more susceptible to systemic toxicity
Application to areas of thin skin may cause atrophy + increased absorption
Prolonged/excessive use may lead to adrenal suppression
Rebound effect may occur after cessation of treatment
Risk of generalised pustular psoriasis with use of topical corticosteroids
Avoid long-term use particularly in infants and children
Maximum duration of treatment 7 days in infants
Advise patient residue on clothing/bedding may cause fire hazard
Fire hazard: Keep away from naked flames and potential sources of ignition
Nappy may act as an occlusive dressing

Supervision is required if used in psoriasis as topical corticosteroids have the potential to be hazardous including rebound relapses following development of tolerance, risk of pustular psoriasis and developments of local and systemic toxicity due to impaired barrier function of the skin.

Hydrocortisone butyrate should not be applied to the eyelids due to the risk of glaucoma simplex or subcapsular cataract.

Pregnancy and Lactation

Pregnancy

Use hydrocortisone butyrate with caution in pregnancy.

At the time of writing there is limited published information regarding the use of hydrocortisone butyrate in human pregnancy. Animal studies have shown some reproductive toxicity and Schaefer (2015) categorise hydrocortisone butyrate as a moderately potent topical glucocorticosteroid. Briggs (2015) states hydrocortisone poses a small risk during pregnancy including dose related teratogenic effects, however the majority of evidence suggests corticosteroids are most likely the cause of those adverse effects. The potential benefit of using hydrocortisone butyrate during pregnancy most likely outweighs the potential risk to the foetus (Briggs et al, 2015).

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 to 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

Use hydrocortisone butyrate with caution in breastfeeding.

Hydrocortisone butyrate is excreted in breast milk. Hale (2014) categorises this topical steroid as an intermediate level of potency stating hydrocortisone butyrate is considered safe to use in breastfeeding when applying the minimal amount, however use with caution when applying to the nipple area.
The manufacturer states the therapeutic dose of hydrocortisone butyrate is unlikely to cause harm to the breastfed infant.

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
Adrenal suppression
Contact dermatitis
Cushing's syndrome
Exacerbation of acne
Exacerbation of infection
Hypersensitivity reactions
Hypertrichosis
Local atrophic changes
Perioral dermatitis
Skin depigmentation
Striae atrophicae (irreversible)
Telangiectasia
Thinning of skin
Worsening of rosacea

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: April 2017

Reference Sources

Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 3rd edition (2015) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G., Freeman, R. Wolters Kluwer Health, Philadelphia.

Joint Formulary Committee. British National Formulary. 72nd ed. London: BMJ Group and Pharmaceutical Press; 2016.

Medications and Mothers' Milk, Sixteenth Edition (2014) Hale, T and Rowe, H, Hale Publishing, Plano, Texas.

Paediatric Formulary Committee. BNF for Children 2016-2017. London: BMJ Group, Pharmaceutical Press, and RCPCH Publications; 2016.

Summary of Product Characteristics: Locoid Cream. Leo Laboratories Limited. Revised February 2021.

Summary of Product Characteristics: Locoid Crelo. Leo Laboratories Limited. Revised February 2021.

Summary of Product Characteristics: Locoid Ointment. Leo Laboratories Limited. Revised February 2021.

Summary of Product Characteristics: Locoid Scalp Lotion. Leo Laboratories Limited. Revised February 2021.