Hydrocortisone

We use Hydrocortisone as a supporting active in custom treatments for acne, hyperpigmentation, melasma, hair loss and beard growth. It is a mild corticosteroid that calms inflammation, redness and itching by damping the skin’s immune response. Your doctor may add it to your formula, usually the first one only, if they deem it beneficial.

What Is Hydrocortisone and How Does It Work?

Hydrocortisone is cortisol, the steroid hormone the body makes itself, manufactured as a medicine. It was the first corticosteroid used on skin, in the early 1950s, and it still defines the mildest of the four potency classes topical steroids are divided into. Inflammation is the skin’s alarm response. Blood vessels widen and the skin turns red and hot. Fluid leaks into the tissue and it swells. Immune cells release the signals that keep it itching and sore. Hydrocortisone damps each step so that the vessels narrow, the leak slows and the signalling quietens. However, it does not treat the underlying cause that set the alarm off.

It is available in licensed creams and ointments for inflammatory conditions such as eczema and dermatitis, which we do not treat. It can also be used in compounded formulas to reduce the irritation that stronger actives cause and calms the inflammation that helps drive pigment production in dark marks and melasma. This may provide the following benefits:

• Calmer hair follicles: some patchy hair and beard loss is driven by inflammation around the follicle. Reducing it supports regrowth.
• Less redness and swelling: this is the core steroid action which eases inflamed skin.
• Relief from itching: one of its licensed uses, and useful when a new treatment makes skin itch in the first weeks.
• A gentler start on strong actives: Tretinoin and other strong actives can leave skin dry and irritated whilst it adjusts. A short initial course of Hydrocortisone reduces that reaction and makes the treatment more tolerable.
• Support in pigment formulas: melasma and post-inflammatory marks are both fed by inflammation, so a mild steroid in the formula supports the actives that suppress the pigment itself.

How City Skin Clinic Uses Hydrocortisone

We sometimes include Hydrocortisone across our skin, hair and beard treatments, always in support of the actives that treat the condition. Every formula we design is built around one person’s main concern and then customised to treat the other concerns alongside it, because everyone’s skin is different. Your doctor sets the strength and the pairings around your skin, your history and what you want to change. We may include Hydrocortisone in the following:

• Acne Treatment
• Hyperpigmentation Treatment
• Melasma Treatment
• Hair Loss Treatment for Men
• Hair Loss Treatment for Women
• Beard Growth Treatment

Hydrocortisone is never the only active in a custom formula. Whether it is included at all is a judgement your doctor makes based on whether you have reactive or easily irritated skin, your formula contains strong actives or have a concern that inflammation is feeding. The doctor usually includes it in the first course only and then removes it, though it can be reintroduced in a later course if the skin needs it. In skin formulas, doctors may pair it with one or more of the following:

• Tretinoin: speeds up cell turnover, smooths texture, treats acne and fades pigment faster.
• Hydroquinone: the strongest pigment suppressor we use for hyperpigmentation, melasma and age spots.
• Azelaic acid: a gentle multi-tasker that clears breakouts, calms redness and fades dark marks, and one of the few actives considered safe in pregnancy.
• Niacinamide: slows the handover of pigment into surface skin cells and supports the barrier alongside stronger actives.
• Tranexamic acid: quietens the signals that switch pigment cells on and is useful in melasma treatment.
• Spironolactone: blocks the androgens driving oil production in hormonal acne.
• Clindamycin: an antibiotic for inflammatory acne.

We may also use Hydrocortisone alongside other actives in hair and beard serums. Your doctor may pair Hydrocortisone with:

• Minoxidil: stimulates regrowth and improves density. It can also irritate some scalps, which Hydrocortisone helps calm.
• Caffeine: stimulates the follicles and improves blood flow to the scalp.
• Melatonin: protects follicles from oxidative stress and supports a healthy growth cycle.
• Tretinoin: a retinoid that may help other actives absorb.
• Spironolactone, Finasteride or Dutasteride: anti-androgens that reduce the effect of androgens on the follicle and may help with some cases of pattern hair loss. These go in hair loss serums only and not in beard formulas because DHT drives facial hair growth.

How Do You Get Hydrocortisone in the UK?

There are three routes to Hydrocortisone in the UK, and which one you need depends on what you are treating. Over the counter, you can buy creams and ointments at up to 1% from any pharmacy. However, the licences set firm limits and state no more than seven days’ use, not on your face without advice from a pharmacist or doctor and not on acne, rosacea, infected or broken skin. Those limits exist because longer use, larger areas and delicate sites all need medical supervision.

Higher strengths, different formulas and longer use require a prescription. Licensed prescription Hydrocortisone runs up to 2.5% and some 1% products are themselves licensed as prescription-only medicines. These are off-the-shelf products available by prescription from regular pharmacies. Compounded formulas are unlicensed prescription treatments made individually for each patient by a specialist pharmacy. Your doctor sets the strength, which can be lower than anything sold over the counter, pairs Hydrocortisone with the actives that treat your condition and adjusts or removes it between courses. Hydrocortisone is also licensed as tablets and injections for conditions elsewhere in the body. We use it on the skin and scalp only.

To access our custom skin and hair treatments, you will need to complete the online consultation form or book a virtual video consultation with one of our doctors first. Your doctor will assess you, design a formula around what your skin or hair needs and look after you afterwards. The same doctor stays with you, adjusts the treatment course by course and answers your questions by email.

There is no subscription and no auto-renewal. Each course is a single order you place yourself when ready.

What Strengths Does Hydrocortisone Come In?

Over the counter, Hydrocortisone products contain up to 1%. Prescription products run up to 2.5%, and even at that strength plain Hydrocortisone stays in the mild class, because potency depends on the molecule as well as the concentration. This is also why hydrocortisone butyrate, found in some prescription products, is a much more potent steroid despite the similar name.

In compounded formulas, Hydrocortisone is usually included at 0.25% for skin and 0.1% for hair and beard, below the over-the-counter strength. This is because its role is support rather than treatment. As with any steroid, your doctor will aim for the lowest strength and the shortest course that your skin needs.

What Are the Side Effects of Hydrocortisone?

Most people tolerate Hydrocortisone well when it is used briefly and at low strength. Its risks rise with strength, duration and the site it is applied to, which is why our courses are short and the strength kept low. The common effects are local and usually settle:

• Burning, stinging or dryness on application: most often in the first days, and usually mild.
• Irritation or a rash where you apply it: less common. Tell your doctor either way, because it may mean the formula wants adjusting.

The better known steroid effects come with longer or stronger use:

• Thinning of the skin: develops with prolonged use, and is more likely in areas of high absorption such as the face and skin folds.
• Stretch marks and small visible blood vessels: both linked to sustained use rather than short courses.
• Skin becoming lighter or darker than usual: a recognised steroid effect, which matters on a pigmentation treatment and is one more reason the course stays short.

One risk is particular to steroids. Using a topical steroid for a long time and then stopping can trigger a rebound called topical steroid withdrawal. The skin flares with intense redness, burning and stinging that can spread beyond where the steroid was applied, sometimes with peeling and oozing spots. It is more likely after long courses on delicate sites such as the face, and the redness can be harder to see on brown or black skin. This is the main reason topical steroids are used in short courses rather than kept on long-term, and it is why Hydrocortisone is usually limited to your first formula. Less common effects to tell your doctor about:

• Blurred vision or any change in your eyesight: reported with topical steroids and needs medical review.
• Wider steroid effects: rare, and linked to prolonged use over large areas. These can, rarely, include unwanted hair growth or hair shedding.

Who Should Not Use Hydrocortisone?

Hydrocortisone in a supervised formula suits most people. There are, however, a few situations that need extra care and some that rule it out:

• Allergy to Hydrocortisone or any ingredient in the formula: an outright reason not to use it.
• Infected or broken skin: steroids are not used on untreated bacterial, viral or fungal skin infections, including cold sores, chickenpox and shingles, because damping the immune response allows infection to spread.
• Rosacea and perioral dermatitis: the licensed products list both as contraindications, because steroids can make them worse.
• Acne on its own: Hydrocortisone is not an acne treatment, and the licensed products list acne among their contraindications, because a steroid used alone can make breakouts worse. When it is included in an acne formula, it is there briefly to reduce early irritation whilst the actives that treat the acne take effect, and only where your doctor judges that right.
• Under 18: our treatments are for adults aged 18 and over, so we do not treat anyone younger.
• Pregnancy and breastfeeding: we do not prescribe hair or beard treatments during pregnancy or breastfeeding at all. For skin, we do not include Hydrocortisone in a pregnancy formula as standard. The NHS advises that most types can be used in pregnancy in small amounts for the shortest possible time, so your doctor decides case by case whether a short course is appropriate. If you are breastfeeding, it should not be applied to the chest area. Pigmentation and melasma can still be treated in pregnancy with a compatible formula, usually built around actives like Azelaic acid.