skin disorders

Hydrocortisone Cream for Eczema: Why You Don’t Need to be Afraid of It

Hydrocortisone cream is one of the most effective treatments for relieving the itching and discomfort associated with eczema, but you may have heard that you shouldn’t use it! Find out why the exact opposite is true and how to get the most out of this controversial treatment.

In This Article:

Whether you have short-term or long-term bouts of eczema, rashes, or any kind of dermatitis, hydrocortisone creams can be your best friend. Topical cortisone creams, which can be either over-the-counter (OTC) or prescription, are known by many names, including corticosteroids, glucocorticosteroids, and steroids. Without question, cortisone creams are considered the "gold standard" for alleviating the symptoms of eczema—when applied correctly, as directed, they’re completely safe to use, even on children. [1,2]


Why Hydrocortisone Cream is Safe and Effective

We know that comment may fly in the face of what you’ve heard about topical cortisones—that they’re really terrible for skin in any circumstance—but research has demonstrated that just isn’t true. [2,3,4]

In fact, not using cortisone cream when it’s called for may lead to more problems for your skin than you would think. We are not saying that there are no risks associated with using cortisone creams—any OTC drug has potential risks—however, their benefits, when used correctly, is the cornerstone to managing your eczema, and can help prevent long-term damage to your skin. Cortisone cream can do this by interrupting and reducing the cascade of chronic inflammation and itching caused by eczema. [2,3]Here’s what’s happening…

At its most severe, your eczema flare-ups may cause your skin to become red, inflamed, itchy, and flaky on various areas of the face and body—sometimes accompanied by small sacs filled with fluid. This outbreak can cause a great deal of damage to skin, both to the upper and lower layers of skin, and more often than not, these eczematous areas are unbearably itchy, enough to trigger uncontrollable and habitual scratching. [2,3]

The inflammation of eczema breakouts, and your reaction to them (scratching), reduces skin’s ability to heal, can cause collagen and elastin to break down, which makes the skin more vulnerable to environmental damage—even a risk of infection. None of this is desirable, and it’s detrimental to the health of skin, over both the short term and long term.

Research demonstrates that when combined with regular use of gentle, fragrance-free reparative moisturizers—and other treatment methods developed with your dermatologist—topical cortisone creams can be incredibly effective in bringing relief to the symptoms of eczema. [2,3]


Thinning Skin and Hydrocortisone Cream?

What are the risks associated with cortisone creams? The primary risk, and what most seem to be concerned about, is thinning of the skin. While that is indeed a risk of using cortisone creams, it is important to stress that this is uncommon, and a risk that develops primarily from long-term, chronic (and excessive) use of cortisone creams. Despite this fact, many people fear thinning of skin is a risk even with responsible use of such treatments, or that it will happen immediately, and that is not the case. [2,3,4]

For many people, cortisone cream is nothing less than a miracle; Paula, the founder of Paula’s Choice Skincare, can personally attest to that, as she’s struggled with eczema to one degree or another for most of her life. Anecdotally, except for the areas where she used it chronically day in and day out for years there have been no negative consequences and the skin in those areas looks completely normal and healthy.

The real story about cortisone is that if it’s used only intermittently to relieve the symptoms, discomfort, and skin damage eczema can cause then there’s no cause for alarm. For example, in the management of flare-ups, research has demonstrated that using a topical cortisone cream twice daily for two-weeks, followed by a week off, is the most common (and effective) approach—and quite safe. [2,3,4]

Using cortisone creams indefinitely, or otherwise irresponsibly, is the problem where side effects are concerned, not intermittent use to stop the symptoms and reactions so skin can begin to heal.


How to Determine which Strength of Hydrocortisone You Need

We recommend speaking to your dermatologist about your situation to develop a long-term strategy to manage your eczema. In general, many will find that OTC options at the drugstore are very effective in managing occasional flare-ups. If those don’t work, you may need to see your doctor for prescription-strength versions. [2,3]

In those situations, it’s not uncommon for the doctor to prescribe two or more preparations of different strengths to be used at the same time, but on different parts of the body. For example, a mild cortisone cream for eczema on your face and a moderately strong version for eczema on the thicker skin of your arms or legs. A very strong topical cream is often needed for eczema on the palms and soles of the feet of adults. These areas have thick skin, and eczema doesn’t respond as well to low-strength cortisone creams.

Remember: Cortisone creams are only as effective as your overall management plan for your eczema—it’s critical that you are avoiding fragranced products, using mild cleansers and well-formulated moisturizers loaded with reparative agents. [2,3,4]Do not make the mistake of relying only on cortisone treatments and ignoring the pivotal role that a good skincare routine can have on reducing the frequency and severity of eczema flare-ups.


How to Use Hydrocortisone Cream on Eczema-Prone Skin

Topical cortisone creams should be used until the flare-up is completely gone—or for two weeks, whichever is first—and then you should stop the treatment and only use it again when another flare-up occurs.

It’s best to use the smallest amount possible that reduces the inflammation and itching; applying more won’t make it work any faster or any better. In some cases, it might require treatment for as little as one day; in other cases, it may take up to 14 days to clear a flare-up. If it takes longer, you’ll want to consult your physician.

Keep in mind that the sooner you apply cortisone cream when you notice a flare-up starting—before it gets bad—reduces the amount of time you’ll need to continue the treatment.

When you weigh the pros and cons of cortisone creams, the research and results are clear: The damage that results from letting inflamed, raw skin linger can be far worse than the effects of intermittent use of a cortisone cream, whether OTC or prescription-only. Don’t let inaccurate information prevent you from taking the best possible care of your skin.

References Cited:

  1. Hong E, Smith S, Fischer G. Evaluation of the atrophogenic potential of topical corticosteroids in pediatric dermatology patients. Pediatr Dermatol. 2011;28(4):393-6.
  2. Hanifin JM, Cooper KD, Ho VC, et al. Guidelines of care for atopic dermatitis, developed in accordance with the American Academy of Dermatology (AAD)/American Academy of Dermatology Association “Administrative Regulations for Evidence-Based CLINICAL Practice Guidelines.” J Am Acad Dermatol. 2004 Mar;50(3):391-404.
  3. Walling HW, Swick BL. Update on the management of chronic eczema: new approaches and emerging treatment options. Clin Cosmet Investig Dermatol. 2010; 3: 99–117.
  4. Charman C, Morris A, Williams H. Topical corticosteroid phobia in patients with atopic eczema. Br J Dermatol. 2000;142(5):931-6.
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