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| Clinical Data | |
|---|---|
| Trade names | Ala-Cort, Aquanil HC, Beta HC, others[1] |
| Clinical data | |
|---|---|
| Trade names | Ala-Cort, Aquanil HC, Beta HC, others[1] |
| Other names | Cortisol; 11β,17α,21-Trihydroxypregn-4-ene-3,20-dione |
| AHFS/Drugs.com | Monograph |
| MedlinePlus | a682206 |
| License data | US DailyMed: Hydrocortisone |
| Pregnancycategory | AU: A[2] |
| Drug class | Corticosteroid; Glucocorticoid; Mineralocorticoid |
| ATC code | A01AC03 (WHO) A07EA02 (WHO), C05AA01 (WHO), D07AA02 (WHO), H02AB09 (WHO), S01BA02 (WHO), S02BA01 (WHO) |
| Legal status | |
| Legal status | * AU: S4 (Prescription only) / S3 / S2 * UK: POM (Prescription only) / P / GSL * US: OTC / Rx-only * EU: OTC / Rx-only |
| Pharmacokinetic data | |
| Elimination half-life | 1.5h[3] |
| Identifiers | |
| IUPAC name | (8S,9S,10R,11S,13S,14S,17R)-11,17-Dihydroxy-17-(2-hydroxyacetyl)-10,13-dimethyl-2,6,7,8,9,11,12,14,15,16-decahydro-1H-cyclopenta[a]phenanthren-3-one |
| CAS Number | 50-23-7 |
| PubChem CID | 5754 |
| DrugBank | DB00741 |
| ChemSpider | 5551 |
| UNII | WI4X0X7BPJ |
| KEGG | D00088 D00165 |
| ChEBI | CHEBI:17650 |
| ChEMBL | ChEMBL389621 |
| Chemical and physical data | |
| Formula | C21H30O5 |
| Molar mass | 362.466 g·mol−1 |
| 3D model (JSmol) | Interactive image |
| SMILES | O=C4\C=C2/[C@]([C@H]1[C@@H](O)C[C@@]3([C@@](O)(C(=O)CO)CC[C@H]3[C@@H]1CC2)C)(C)CC4 |
| InChI | InChI=1S/C21H30O5/c1-19-7-5-13(23)9-12(19)3-4-14-15-6-8-21(26,17(25)11-22)20(15,2)10-16(24)18(14)19/h9,14-16,18,22,24,26H,3-8,10-11H2,1-2H3/t14-,15-,16-,18+,19-,20-,21-/m0/s1 Key:JYGXADMDTFJGBT-VWUMJDOOSA-N |
| (what is this?) (verify) | |
Topical hydrocortisone is a drug under the class of corticosteroids, which is also known as steroids.[4] It is used for the treatment of skin inflammation, itchiness and allergies.[5] Some examples include insect bites, dermatitis and rash.[6][7][8]
The most common adverse effects after the application of topical hydrocortisone are burning and stinging sensations.[5][6] Side effects after long-term usage include eyesight damage, elevated blood sugar levels and adrenal gland disorders.[7]
Topical hydrocortisone is available in several dosage forms such as solution, lotion, cream, ointment and spray.[9] Some brand names for topical hydrocortisone include Anusol HC®, Cortizone 10®, and Synacort®.[9]
Medical use
[edit]Topical hydrocortisone is indicated for relieving swelling, irritation and redness in a number of skin conditions, including insect bites, heat rash, eczema, psoriasis, contact dermatitis and nappy rash.[4][7][9][10] It could be formulated as a single active ingredient in some medications, e.g. Cortaid®, which is applied for anal itchiness.[8][11][12] On some occasions, this drug may be used in combination with other types of drugs to alleviate skin problems.[8][13] For example, it could be used together with antibiotics such as polymyxin, neomycin and bacitracin to improve dermal conditions.[13]
History
[edit]In the 1930s, hydrocortisone was found by biochemist Edward C. Kendall and rheumatologist Philip S. Hench, who were both Nobel laureates.[14][15][16] When they were investigating therapies for rheumatoid arthritis, they discovered that patients who were simultaneously pregnant, or suffering from jaundice, would experience an alleviation of their condition.[15][16] Following this finding, they extracted different hormones from the adrenal cortex of cows in search of a suitable drug.[15][16][17] They first identified cortisone to be one of the possible drugs, and further research led them to discover an effective drug for human dermal problems, which was hydrocortisone.[15][16][17]
After the discovery of hydrocortisone, the earliest application of hydrocortisone as a topical form in humans was recorded in 1952, and its successful utilization facilitated more research on topical corticosteroids, which helped the development of similar drugs with higher activity.[16][17][18]
Formulations
[edit]Topical hydrocortisone is formulated as liquid, solution, lotion, cream, gel, ointment, foam, and spray.[19] The strength of topical hydrocortisone products ranges from 0.1% to 2.5%, which means there could be 1mg to 25mg hydrocortisone in 1g of the products.[7] Some formulations for topical hydrocortisone include hydrocortisone 0.5% cream or ointment, hydrocortisone 1% cream or ointment, and hydrocortisone 2.5% cream or ointment.[20] Regarding the method of applying the medications, please refer to the package insert or consult a pharmacist.
Some less common forms of topical hydrocortisone are also available in the market. For example, hydrocortisone butyrate is a relatively potent topical hydrocortisone cream that can only be purchased when you have a valid prescription.[7] Besides, some forms of topical hydrocortisone are mixed with antimicrobial drugs to treat bacterial or fungal problems of the skin.[7]
Pharmacology
[edit]Pharmacokinetics
[edit]Topical hydrocortisone has minimal absorption into the body: Only 4-19% of the topical hydrocortisone cream applied would be absorbed into the human bloodstream.[14] After a certain extent of absorption, it would undergo distribution, metabolism and elimination pathways that are similar to systemic hydrocortisone.[21] Regarding the distribution of topical hydrocortisone, it binds to plasma proteins such as globulin and albumin, then the drug is mainly metabolized in the liver, and the metabolite will be excreted through bile or by kidneys.[21]
Pharmacodynamics
[edit]Hydrocortisone would bind to glucocorticoid receptors in the human body, which reduces the production of inflammatory transcription factors, phospholipase A2, and NF-kappa B, as well as increases the expression of anti-inflammatory genes.[14] In addition, hydrocortisone has a relatively wide therapeutic window,[14] implying that toxicity is less likely to occur.
Mechanism of action
[edit]Topical hydrocortisone contributes to inflammatory-reducing activity in various ways.[22] Firstly, hydrocortisone can bind to glucocorticoid receptors in the cytoplasm, causing the receptors to enter the nucleus to upregulate genes for reducing inflammation such as lipocortin.[22] Then, lipocortin inhibits phospholipase A2, an enzyme preventing the synthesis of prostaglandins and lipoxygenases.[22] After that, hydrocortisone stabilises the lysosomes in neutrophils, which are a type of white blood cell.[22] Hence, the neutrophils would not degranulate, preventing inflammation.[22] Eventually, mRNA segments are destabilized, affecting gene transcription and interrupting the gene production of cytokines, chemokines, cyclooxygenase-2, etc.[22]
Instruction of use
[edit]Before and after applying topical hydrocortisone, clean your hands with soap and water.[1][6][23] Shake the medicine well if topical hydrocortisone is formulated as a lotion, foam, or spray.[1][6] The medication should be applied thinly, only at the affected locations on the skin.[1][5][6][9][10][21][23] The affected locations should be unbroken.[10] Then, rub the medication on the affected area gently.[1][6][9][23] Concerning the frequency of use, it is common to apply it 1 or 2 times daily for 1 to 2 weeks.[7] The 2 dosages should be separated by 8-12 hours if you need to use topical hydrocortisone 2 times a day.[7] Regarding the amount of cream required in an application, it can be measured by fingertip units: one fingertip unit is sufficient to apply the cream on both sides of your hand.[7] For specific usage, please refer to the package insert or discuss it with a healthcare professional.
Please note that topical hydrocortisone should not be used for more than 1 week unless it is instructed by a doctor.[7][8] Consult a doctor before applying the medication to children younger than 10.[7]
If you would like to use another skin product at the same time, please separate the use of topical hydrocortisone and the other topical product for at least 30 minutes,[10] or apply another product at a different time in the day.[7]
Topical hydrocortisone should be stored in an isolated container at room temperature instead of being kept in a fridge.[1][10][21][23] Heat, moisture, and direct light should be avoided.[23] The location should also not be reachable for children.[10]
In case you missed a dose, you can apply topical hydrocortisone immediately, but if the time is near the next dose, do not replenish the missed dose.[1][6][9] Do not use double the amount of topical hydrocortisone in situations where you missed a dose.[1][6][9]
Caution
[edit]Topical hydrocortisone should only be used on the skin.[9] Be aware not to apply the drug to the eyes or mouth.[6][9] If topical hydrocortisone entered the eyes or mouth, wash the drug away with a large amount of water.[6] Avoid applying it on genitals, infected skin and broken skin.[7] It is also not recommended to apply topical hydrocortisone on the face unless this is approved by a healthcare professional as this could worsen the existing skin problems.[7] Please consult a medical professional before applying a dressing or diapers on the site with topical hydrocortisone if needed.[1][6][21][23] Cosmetics should also not be applied on the areas with topical hydrocortisone.[10][23] Moreover, avoid applying tight dressings on the area with topical hydrocortisone applied without advice from healthcare professionals.[9][21]
The drug may not be applicable to all individuals. In the following situations, you should consult a doctor or pharmacist before applying it:
- Having an allergy to hydrocortisone or other drugs
- Having a dermal or ocular infection
- Being pregnant, going to be pregnant or breastfeeding[7]
On the other hand, clothes and bedsheets with dried creams on them would catch fire more easily.[7] Hence, after applying topical hydrocortisone, you should minimize contact with naked flames.[7]
If your symptoms do not improve or deteriorate after using topical hydrocortisone for a few days, you should inform your doctor for a re-examination.[1][5][23]
Adverse effects
[edit]Some common side effects include burning and stinging sensations.[5][6][10][23] Colour change of the skin, bump formation on the skin and additional hair growth could also occur. [6][9] Consult a doctor if these side effects persist or become worse.[6][9]
Some severe side effects are severe rash, swelling of the skin, and skin infection.[9] Rare but serious allergic reactions, also known as anaphylaxis, could also occur.[7] If you encounter any of these side effects, you should approach a doctor immediately.[9]
Adverse effects after the long-term use of topical hydrocortisone include adrenal gland disorders.[23] This problem can be more severe when you use excess topical hydrocortisone for a prolonged period of time.[23] Other adverse effects include blurry vision, dizziness, fainting, unusual heartbeat, thirsty sensation, frequent urination, and fatigue.[23] Please inform your doctor if you experience any of these symptoms.[23]
References
[edit]- ^ a b c d e f g h i j k "Hydrocortisone topical Uses, Side Effects & Warnings". Drugs.com. Retrieved 2023-03-11.
- ^ "Hydrocortisone topical Use During Pregnancy". Drugs.com. Retrieved 2023-02-26.
- ^ Lennernäs, Hans; Skrtic, Stanko; Johannsson, Gudmundur (2008-06-01). "Replacement therapy of oral hydrocortisone in adrenal insufficiency: the influence of gastrointestinal factors". Expert Opinion on Drug Metabolism & Toxicology. 4 (6): 749–758. doi:10.1517/17425255.4.6.749. ISSN 1742-5255. PMID 18611115.
- ^ a b "Hydrocortisone: a steroid used to treat many health conditions". nhs.uk. 2019-03-26. Retrieved 2023-02-26.
- ^ a b c d e "Pandel (hydrocortisone probutate topical) dosing, indications, interactions, adverse effects, and more". reference.medscape.com. Retrieved 2023-02-26.
- ^ a b c d e f g h i j k l m n "Hydrocortisone Topical: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing - WebMD". www.webmd.com. Retrieved 2023-02-26.
- ^ a b c d e f g h i j k l m n o p q r "Hydrocortisone for skin: a steroid medicine for treating eczema, psoriasis and insect bites". nhs.uk. 2019-01-17. Retrieved 2023-02-26.
- ^ a b c d "What Is Hydrocortisone Cream Used For? Side Effects". MedicineNet. Retrieved 2023-03-04.
- ^ a b c d e f g h i j k l m n "Hydrocortisone Topical: MedlinePlus Drug Information". medlineplus.gov. Retrieved 2023-02-26.
- ^ a b c d e f g h "Drug Office - Topical Corticosteroids". Drug Office, Department of Health, Hong Kong. June, 2013. Retrieved 4 Mar, 2023.
{{cite web}}: Check date values in:|access-date=and|date=(help)CS1 maint: url-status (link) - ^ "Pruritus Ani (Anal Itch)". Section of Colon and Rectal Surgery. 2015-01-26. Retrieved 2023-03-04.
- ^ "Cortaid (Hydrocortisone Cream and Ointment 1.0%): Uses, Dosage, Side Effects, Interactions, Warning". RxList. Retrieved 2023-03-04.
- ^ a b "Neomycin, Polymyxin, Bacitracin, and Hydrocortisone Topical: MedlinePlus Drug Information". medlineplus.gov. Retrieved 2023-03-04.
- ^ a b c d "Hydrocortisone". go.drugbank.com. Retrieved 2023-02-26.
- ^ a b c d "The Nobel Prize in Physiology or Medicine 1950". NobelPrize.org. Retrieved 2023-03-04.
- ^ a b c d e academic.oup.com. doi:10.1373/clinchem.2010.149120 https://academic.oup.com/clinchem/article/56/8/1349/5622293. Retrieved 2023-03-04.
{{cite web}}: Missing or empty|title=(help) - ^ a b c Mehta, Aayushi B.; Nadkarni, Nitin J.; Patil, Sharmila P.; Godse, Kiran V.; Gautam, Manjyot; Agarwal, Shweta (2016-07-01). "Topical corticosteroids in dermatology". Indian Journal of Dermatology, Venereology and Leprology. 82: 371. doi:10.4103/0378-6323.178903. ISSN 0378-6323. PMID 27279294.
{{cite journal}}: CS1 maint: unflagged free DOI (link) - ^ Mukhopadhyay, Sandip; Kwatra, Gagandeep (2018), Lahiri, Koushik (ed.), "Evolution and Development of Topical Corticosteroids", A Treatise on Topical Corticosteroids in Dermatology: Use, Misuse and Abuse, Singapore: Springer, pp. 1–9, doi:10.1007/978-981-10-4609-4_1, ISBN 978-981-10-4609-4, retrieved 2023-03-04
- ^ "Hydrocortisone (Topical Application Route) Description and Brand Names - Mayo Clinic". www.mayoclinic.org. Retrieved 2023-02-26.
- ^ "Search Results - (emc)". www.medicines.org.uk. Retrieved 2023-02-26.
- ^ a b c d e f "Hydrocortisone Cream: Package Insert / Prescribing Information". Drugs.com. Retrieved 2023-02-26.
- ^ a b c d e f "Topical Corticosteroid - an overview | ScienceDirect Topics". www.sciencedirect.com. Retrieved 2023-03-04.
- ^ a b c d e f g h i j k l m "Hydrocortisone (Topical Application Route) Side Effects - Mayo Clinic". www.mayoclinic.org. Retrieved 2023-03-04.