Hydrocortisone (steroid) cream for acne: Is it safe and effective?

Key takeaways:

• Hydrocortisone is one of the classes of drugs called steroids or corticosteroids. But, it is the least potent steroid in the classification of steroid potency.
• Hydrocortisone can help treat acne by reducing itchiness, swelling, and redness associated with acne.
• While it may help with some acne symptoms, hydrocortisone can cause some adverse reactions, such as worsening skin problems like impetigo and rosacea, especially under unsupervised conditions.

What is Hydrocortisone? Is it a steroid?

Hydrocortisone belongs to a class of drugs called steroids that can suppress the immune system, inhibit cell growth, and have anti-inflammatory properties.

It reduces symptoms like swelling, itching, and redness, which makes it beneficial in treating and managing several skin issues, such as eczema, psoriasis, allergic conditions, and acne.

Amongst all steroids, hydrocortisone 1.0 and 2.5% cream, lotion, or ointment are the least potent and mildest, with the fewest side effects. According to the United States classification of steroid potency, they belong to class VII, making them the approved steroid for the face, infants, sensitive skin, mucous membranes, and when the steroid-responsive condition is not severe. 

Does Hydrocortisone cream work for acne?

Hydrocortisone may work for treating some acne symptoms. As an anti-inflammatory agent, hydrocortisone cream reduces the swelling, itching, and redness of acne. Although this is not enough to make hydrocortisone a permanent acne treatment, it is a good option to consider if you are looking for an ingredient to ease inflammatory symptoms temporarily.

Steroids are not the medication of choice for aestheticians when handling patients with acne unless they are dealing with severe inflammation. It is combined with antibiotics or other acne treatments to make it more effective.

Is Hydrocortisone cream safe to use?

Even with a positive effect on acne, care should be taken when using hydrocortisone cream, especially for the face and around the eye, because the skin in these areas is thin and sensitive, and penetration is 300 times greater through thin epidermis like the eyelids compared to other body sites.

The anti-inflammatory action of hydrocortisone can be fast and soothing that you forget it’s a steroid, which can cause serious side effects if misused. 

It’s important to note that excessive use of topical steroids can cause an increase in the concentration of free fatty acids, thereby causing an increase in oil/sebum production and fostering an environment for bacteria growth, eventually triggering acne.

How does hydrocortisone cream treat cystic acne and pimples?

Cystic acne is a type of acne that is accompanied by inflammation. This causes painful, pus-filled pimples to form deep under the skin, hence the need for hydrocortisone treatment. 

So the role of the hydrocortisone cream in treating cystic acne is to reduce the inflamed site making it easier for other active ingredients to work on the affected area. 

Although hydrocortisone can be used in cystic acne treatment, it is noteworthy that it is not ideal for permanent treatment. Rather it should be used temporarily.  

Forms of hydrocortisone

Topical hydrocortisone is formulated as creams, lotions, gels, ointments, and foams to improve drug delivery, and a clear view of its different forms can help you make the right choice for your skin.

Hydrocortisone creams

Hydrocort creams are better for moist and teary skin because they are more appealing and don't leave a sticky residue. However, they are not as effective. 

Because they are non-occlusive and have a drying effect, they are often used to treat certain inflammations that cause fluid to seep out of the skin, as well as itchiness, rash, and redness in areas of skin that rub against each other.

Hydrocortisone ointments

They are the most potent and occlusive forms of hydrocortisone. Still, experts advise people not to apply them on hair-bearing regions because they may result in inflammation of hair follicles.

Hydrocortisone lotions

Like creams, hydrocort lotions are less occlusive and greasy and work well in hair-bearing regions, making them more beneficial for the scalp.

Hydrocortisone gels

Gel is another option if you prefer gels to lotions. They are also more beneficial for the scalp and hair-bearing regions.

Hydrocortisone foams

Hydrocortisone foams are high-end products but highly effective for delivering steroids to the scalp.

You will need the help of a dermatologist when choosing a topical hydrocortisone cream for your skin.

How to use hydrocortisone for treating acne

Dermatologists advise using the fingertips unit because the amount of hydrocortisone cream applied to the skin matters.

Why the fingertip unit?

The fingertips unit regulates the amount of hydrocortisone cream applied to the skin and reduces the chances of overuse that may result in adverse effects.

To use the Fingertips unit method, follow these steps;

• Open the topical hydrocortisone cream.
• Introduce a pea size at the fingertips of the index finger or any finger.
• Gently disperse the topical cream in the affected area. 
• Allow the cream to absorb in the skin for 10 minutes before moisturizing.

Side effects of Hydrocortisone creams

Side effects associated with hydrocortisone creams are grouped into two categories: 

• Local side effects: Side effects that occur at the site of the medication's contact
•  Systemic side effects: Side effect occurs in the tissues distant from the site of the medication’s contact

 Local side effects of hydrocortisone creams include:

• Acne (monomorphic, comedonal, mild infantile acne)
• Skin thinning
• Steroid rosacea
• Stretch marks
• Spider veins
• Small inflammatory papules and pustules around the mouth called Perioral dermatitis
• Decreased skin elasticity
• Delayed skin recovery
• Impaired wound healing

Systemic side effects of hydrocortisone include:

• Glaucoma
• Hypertension
• Hyperglycemia 
• Cushing syndrome

These side effects are rare with hydrocortisone cream unless it is used in large quantities unsupervised consistently for a long time.

Precautions to take when using steroids for acne

• Start with the weakest strength and gently switch to a higher dose if necessary.
• Do not use hydrocortisone cream for more than a week, and if there is a need to extend, talk to a doctor.
• Do not use hydrocortisone cream on the face if your dermatologist does not prescribe or approve it. This is because it can worsen skin problems like impetigo, rosacea, and acne
• Hydrocortisone cream can be used for children under 10 years if prescribed by a dermatologist. 
• Stop using hydrocortisone cream once you feel okay. 
• Reduce the frequency of use application to alternate day or weekend-only therapy. You can use it once or twice a day if need be. 
• If you use hydrocortisone cream twice a day, try to leave a gap of 8-12 hours before putting on any more. 
• Wait 10 minutes before applying any other moisturizer. 
• Take care in treating children and elderly persons, especially in certain places like the face.

When to see a dermatologist

Although side effects are rare when using hydrocortisone cream, allergic reactions are possible. 

Report to a dermatologist if you feel any of these:

• Rashes
• Itches
• Redness, swollen, xc blistered, or peeling skin.
• Wheezing, tightness in the chest or throat, or problem breathing

Wrap up

The benefits of hydrocortisone cream for acne depend on an accurate diagnosis, choosing the right strength, choosing the right form for administration, and the frequency of application.

When confused about the form of topical hydrocortisone to use or whether to use it at all, consult a dermatologist.