hydrocortisone topical (Rx, OTC)

Frequency Not Defined

Skin atrophy

Striae

Acneform lesions

Perioral dermatitis

Folliculitis

Itching

Pigmentation changes

HPA suppression (with higher potency used >2 wk)

Contraindications

Underlying infection

Hypersensitivity

Ophthalmic use

Treatment of diaper dermatitis

Cautions

Chronic topical corticosteroid therapy may interfere with growth and development in children

Use lower potency in children; may absorb proportionally larger amounts after topical application and may cause systemic effects

Occlussive dressings, prolonged use, application to large surface areas, or application to denuded skin, may increase percutaneous absorption, which may result in cushing syndrome, glycosuria, and hyperglycemia

Prolonged use may increase risk of Kaposi's sarcoma

Prolonged use may increase risk of secondary infection, may mask acute infection, limit response to vaccines, and prolong or exacerbate viral infections; avoid exposure to measles or chickenpox while receiving therapy; not for the treatment of ocular herpes simplex, cerebral malaria, fungal infections, or viral hepatitis; observe patients with latent tuberculosis closely; restric use in active tuberculosis

Acute myopathy reported with high dose corticosteroids, especially patients with neuromuscular transmission disorders

Psychiatric disturbances including euphoria, insomnia, mood swings, and personality changes reported with corticosteroid use

Allergic contact dermatitis may occur; diagnosed as failure to heal rather than exacerbation; discontinue therapy and treat appropriately if it occurs

May suppress hypothalamic-pituitary-adrenal axis, especially in patients receiving high doses for prolonged periods of time and younger children, which may result in adrenal crisis

Anaphylactoid reactions reported in patients receiving corticosteroids

Local desensitization (irritation, redness) reported; discontinue if it occurs

Use caution in patients with diabetes, cardiovascular disease, hepatic impairment, myocardial infarction, myasthenia gravis, osteoporosis, ocular disease, renal impairment, or thyroid disease

Pregnancy

There are no adequate and well-controlled studies in pregnant women on teratogenic effects from topically applied corticosteroids; corticosteroids generally teratogenic in laboratory animals when administered systemically at relatively low dosage levels; topical corticosteroids should be used during pregnancy only if potential benefits justify potential risk to fetus; should not be used extensively on pregnant patients, in large amounts, or for prolonged periods of time

Lactation

Not know whether topical administration could result in sufficient systemic absorption to produce detectable quantities in breast milk; systemically administered corticosteroids are secreted into breast milk in quantitis not likely to have deleterious effect on infant; nevertheless, caution should be exercised when topical corticosteroids are administered to a nursing woman

Pregnancy Categories

A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

NA: Information not available.

Mechanism of Action

Decreases inflammation by stabilizing leukocyte lysosomal membranes, preventing release of destructive acid hydrolases from leukocytes

Inhibits macrophage accumulation in inflamed areas

Reduces leukocyte adhesion to capillary endothelium

Reduces capillary wall permeability and edema formation

Decreases complement components and antagonizes histamine activity and release of kinin from substrates

Reduces fibroblast proliferation, collagen deposition, and subsequent scar tissue formation

Absorption

Percutaneous; extent of absorption in dependent on formulation, epidermal integrity (intact vs abrated), and the use of occlusive dressings