Drugs List

Therapeutic Indications

Uses

Dermatitis
Eczema
Insect bites

'POM' products
For the treatment of eczema and dermatitis including atopic eczema, photodermatitis, intertrigo, primary irritant and allergic dermatitis, prurigo nodularis, seborrhoeic dermatitis and insect bite reactions.

Contraindications

Open wounds
Acne vulgaris
Perioral dermatitis
Rosacea
Skin infection
Skin ulcer

Precautions and Warnings

Occlusive dressings
Breastfeeding
Pregnancy

Careful supervision of patients with psoriasis required
Not all available brands are licensed for all age groups
Some formulations contain propylene glycol
Avoid prolonged application to the face
Do not apply to broken or denuded skin
Do not apply to periorbital skin
Keep away from the eyes
Prolonged continuous use increases the risk of systemic toxicity
Rebound effect may occur after cessation of treatment
Some formulations contain chlorocresol, may cause allergic reactions
Discontinue if hypersensitivity reactions occur
Avoid long-term use particularly in infants and children
Treatment should not exceed 7 days in infants
Advise patient residue on clothing/bedding may cause fire hazard
Advise patient to consult physician if condition worsens / does not improve
Fire hazard: Keep away from naked flames and potential sources of ignition
Nappy may act as an occlusive dressing

Prolonged continuous use may cause adrenal suppression.

Avoid prolonged administration to the flexures and other areas of thin skin.

When treating inflammatory lesions which become infected, suitable antimicrobial therapy should be used and any spread of infection requires the withdrawal of treatment.

Use with caution in dermatosis of infancy including napkin eruption.

Pregnancy and Lactation

Pregnancy

Use hydrocortisone with caution in pregnancy.

There is inadequate evidence of safety in human 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.

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 with caution in breastfeeding.

There is no evidence against use in lactating women. However caution should be exercised when topical hydrocortisone is administered to nursing mothers. In this event the product should not be applied to the chest area.

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
Cushing's syndrome
Exacerbation of infection
Hypercortisolism
Hypersensitivity reactions
Hypertrichosis
Mild depigmentation and vellus hair
Perioral dermatitis
Striae (irreversible)
Suppression of the hypothalamic-pituitary-adrenal axis
Telangiectasia
Thinning of skin
Worsening of rosacea

Presentation

Topical formulation of hydrocortisone

Drugs List

Therapeutic Indications

Uses

Dermatitis
Eczema
Insect bites

'POM' products
For the treatment of eczema and dermatitis including atopic eczema, photodermatitis, intertrigo, primary irritant and allergic dermatitis, prurigo nodularis, seborrhoeic dermatitis and insect bite reactions.

Dosage

Different brands have different dosing regimens.

Hydrocortisone cream is usually suitable for moist or weeping surfaces, whereas the ointment formulation should be considered for dry, scaly or lichenified conditions.

Adults

Elderly

Children

Neonates

Additional Dosage Information

Contraindications

Open wounds
Acne vulgaris
Perioral dermatitis
Rosacea
Skin infection
Skin ulcer

Precautions and Warnings

Occlusive dressings
Breastfeeding
Pregnancy

Careful supervision of patients with psoriasis required
Not all available brands are licensed for all age groups
Some formulations contain propylene glycol
Avoid prolonged application to the face
Do not apply to broken or denuded skin
Do not apply to periorbital skin
Keep away from the eyes
Prolonged continuous use increases the risk of systemic toxicity
Rebound effect may occur after cessation of treatment
Some formulations contain chlorocresol, may cause allergic reactions
Discontinue if hypersensitivity reactions occur
Avoid long-term use particularly in infants and children
Treatment should not exceed 7 days in infants
Advise patient residue on clothing/bedding may cause fire hazard
Advise patient to consult physician if condition worsens / does not improve
Fire hazard: Keep away from naked flames and potential sources of ignition
Nappy may act as an occlusive dressing

Prolonged continuous use may cause adrenal suppression.

Avoid prolonged administration to the flexures and other areas of thin skin.

When treating inflammatory lesions which become infected, suitable antimicrobial therapy should be used and any spread of infection requires the withdrawal of treatment.

Use with caution in dermatosis of infancy including napkin eruption.

Pregnancy and Lactation

Pregnancy

Use hydrocortisone with caution in pregnancy.

There is inadequate evidence of safety in human 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.

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 with caution in breastfeeding.

There is no evidence against use in lactating women. However caution should be exercised when topical hydrocortisone is administered to nursing mothers. In this event the product should not be applied to the chest area.

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
Cushing's syndrome
Exacerbation of infection
Hypercortisolism
Hypersensitivity reactions
Hypertrichosis
Mild depigmentation and vellus hair
Perioral dermatitis
Striae (irreversible)
Suppression of the hypothalamic-pituitary-adrenal axis
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: January 2016

Reference Sources

Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 2nd edition (2007) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 9th edition (2011) ed. Briggs, G., Freeman, R. and Yaffe, S. Lippincott Williams & Wilkins, Philadelphia.

Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press Accessed on 14 January 2016.

Paediatric Formulary Committee. BNF for Children (online) London: BMJ Group, Pharmaceutical Press, and RCPCH Publications Accessed on 14 January 2016.

Summary of Product Characteristics: Dioderm 0.1% w/w Cream. Dermal Laboratories Ltd. Revised January 2015.

Summary of Product Characteristics: Dermacort Hydrocortisone Cream. Marlborough Pharmaceuticals Ltd. Revised March 2007.

Summary of Product Characteristics: Hydrocortisone Cream BP 0.5%. Actavis UK Ltd. Revised July 2015.
Summary of Product Characteristics: Hydrocortisone Cream BP 1.0%. Actavis UK Ltd. Revised July 2015.

Summary of Product Characteristics: Hydrocortisone 1.0% Bite and Sting Relief Cream. Teva UK Ltd. Revised July 2011.
Summary of Product Characteristics: Hydrocortisone 0.5% Cream. Teva UK Ltd. Revised July 2015.
Summary of Product Characteristics: Hydrocortisone 2.5% Cream. Teva UK Ltd. Revised July 2015.
Summary of Product Characteristics: Hydrocortisone 0.5% Ointment. Teva UK Ltd. Revised July 2015.
Summary of Product Characteristics: Hydrocortisone 1.0% Ointment. Teva UK Ltd. Revised July 2015.
Summary of Product Characteristics: Hydrocortisone 2.5% Ointment. Teva UK Ltd. Revised July 2015.

Summary of Product Characteristics: Mildison Lipocream. Astellas Pharma Ltd. Revised April 2015.

Summary of Product Characteristics: Pinewood's Bites and Stings Relief Cream. Pinewood Healthcare. Revised December 2015.

Summary of Product Characteristics: Zenoxone, Hydrocortisone Cream, Hydrocortisone 1% Cream. Teva UK Ltd. Revised July 2015.