Hydrocortisone is a naturally occurring corticosteroid in humans. Currently, it is synthesized in laboratories. It is one of the most widely used steroids in dermatology. It is readily prescribed to patients as an ingredient of made ointments. It effectively deals with atopic dermatitis or impetigo. Patients often come to the pharmacy for hydrocortisone without a prescription in the form of a ready-made cream, but you should consciously use this preparation in order not to harm yourself.
How does hydrocortisone work?
Hydrocortisonebelongs to a group of steroids called glucocorticoids.
To understand what action hydrocortisone has, you should first look at its physiological role in the human body. The secretion of cortisol and hydrocortisone is coordinated by the hypothalamic-pituitary-adrenal cortex axis. These organs are interconnected and form an efficient system. The secretory capacity of one element influences the secretion of hormones by the other elements.
This interaction is based on negative feedback. An increase in the concentration of adrenal cortex hormones, e.g. cortisol, inhibits the secretion of hypothalamic and pituitary hormones and, as a result, a decrease in blood cortisol levels.
Hydrocortisone works:
- anti-inflammatory
- anti-rheumatic
- antiallergic
- anti-shock
- immunosuppressive
- has the ability to modulate the immune response
- inhibits the permeability of capillaries
- reduces swelling
- inhibits the action of hyaluronidase.
It is also worth remembering that hydrocortisone:
- increases blood glucose levels
- accelerates the breakdown and inhibits protein synthesis
- reduces the body's ability to defend itself against infections
- causes sodium and water to be retained in the body
- leads to potassium loss in urine
- increases the amount of calcium passing from the bones into the bloodstream
- reduces the absorption of calcium in the digestive system and increases the excretion of this element in the urine
- may cause growth retardation in children and adolescents.
Hydrocortisone is given as a tablet, intravenous infusion, intramuscular injection or cream.
Its administration per os or i.v increases the probability of side effects. The body's physiological reaction to the administration of an increased amount of this compound is the inhibition of the body's secretion of its own physiological hormone. It is an inhibition of the action of the hypothalamic - pituitary - adrenal cortex axis.
Indications for the use of hydrocortisone
The indications for the use of hydrocortisone vary and are often related to the form of the drug chosen by the doctor.
Intravenous or intramuscular administration is usually reserved for inpatient care. Often the decision to administer intravenously, by infusion or intramuscularly is made by the emergency room doctor or paramedic, as these are life-threatening conditions.
The indications for the use of hydrocortisone mentioned in the recommendations include :
- primary or secondary adrenal insufficiency
- shock states (post-traumatic, postoperative, cardiogenic, anaphylactic, transfusion, post-burn)
- severe bronchospastic states
- acute allergic conditions - Quincki's angioedema
- severe erythema multiforme - Stevens-Johnson syndrome
- acute forms of autoimmune diseases
- acute drug hypersensitivity reaction.
The dose and speed of administration are determined by the medical specialist. Usually, despite the difficult condition of the patient, doctors try to select the lowest effective dose to prevent possible side effects.
Hydrocortisone given by injection or infusion is succinate.
Oral tablet administration is a much more common form.
Hydrocortisone tablets can be prescribed by a physician in conditions such as:
- need for substitution in primary or secondary adrenal insufficiency
- injuries or diseases of people diagnosed with adrenal insufficiency
- patients with uncertain adrenal cortex reserve
By far the most common form is hydrocortisone cream. The preparations available on the market are both OTC - over the counter and those with a higher concentration on prescription.
The indications for topical hydrocortisone use are:
- atopic dermatitis
- lichen erythematosus
- erythema multiforme
- lichen planus with severe itching
- seborrheic dermatitis
- various forms of eczema, especially lichen eczema
- scalp psoriasis, old-age psoriasis
- scabies
- continuation of treatment with potent drugsglucocorticosteroids.
The form of topical administration is by far the safest for the patient because when properly controlled, it entails a minimum number of side effects.
Hydrocortisone cream comes in the form of acetate.
Hydrocortisone dosage
A specialist doctor always aims to administer the lowest effective dose of hydrocortisone. At the same time, the patient is instructed not to use hydrocortisone on he althy skin, if it is used in a cream. The duration of the therapy is also recommended as short as possible.
Dosage of hydrocortisone in a hospital setting will not be discussed because the specialist physician decides the dosage. This is a very individual issue and it will not be the same for every patient.
Hydrocortisone dosage in tablet form
As above, it is an individual matter. It depends on the condition of the patient, his disease entity and the way he will react to treatment. It is always recommended to prescribe the lowest dose possible.
Hydrocortisone doses usually recommended in chronic adrenal insufficiency are 20-30 mg / 24h.
Hydrocortisone dosage for children and adolescents depends on body weight and amounts to 0.4-0.8 mg / kg body weight per day, usually in divided doses.
Topical application to the skin is clear enough for the patient to decide on the use of hydrocortisone and to safely administer the therapeutic treatment.
Specialists recommend applying a thin layer of cream only to the affected area 2-3 times a day. Usually improvement occurs quickly, the patient should stop the treatment after 7 days. In a situation where a doctor prescribes a cream with a higher dose of hydrocortisone on a prescription, follow its indications.
Contraindications to the use of hydrocortisone
Contraindications to the use of hydrocortisone vary and depend, among others, on on the form of the drug.
Contraindications to the use of hydrocortisone in the form of injections and tablets:
- hypersensitivity to hydrocortisone
- systemic fungal infection.
Contraindications to the topical use of hydrocortisone are:
- hypersensitivity to hydrocortisone or other ingredients of the cream
- bacterial, viral, fungal infections
- ordinary acne, rosacea
- skin atrophy
- cancer and precancerous skin conditions
- dermatitis perioralis
- tuberculous skin lesions
- use on open wounds and damaged skin
- concomitant systemic mycosis.
How to safely use hydrocortisone? Precautions
Patients who make their own decisions to use hydrocortisone should be instructed by the pharmacist that the longest recommended duration of topical hydrocortisone use is 3 days for the face and 7 days for the rest of the body.
Essential Recommendations Precautions:
- If a significant area of the body is diseased, the patient should still consult a doctor before starting the self-treatment.
- The longer the application time and the larger the area of the treated skin, the greater the likelihood of adverse effects. Hydrocortisone is absorbed through the skin, therefore there is a risk of systemic side effects despite the topical use of the product.
- It is not recommended to use corticosteroids on a wounded or exposed site, if it is necessary to use ointment on infected skin, use hydrocortisone in combination with a bactericide and antifungal agent.
- As the skin of the face and the armpits is delicate, in these areas there is an increased absorption of the applied corticosteroid, therefore these areas should be treated after consulting a specialist, as short as possible and with the lowest dose.
- Avoid using the corticosteroid around the eyes and on the eyelids as there is a high risk of glaucoma or cataracts in the patient.
- The application of the cream under occlusive dressing (i.e. oilcloth, diaper) should be avoided because in such conditions the absorption of hydrocortisone increases.
- When using a systemic corticosteroid (injection, tablet), remember not to undergo vaccinations, as the patient's immune response is impaired.
- People infected with smallpox or shingles should be avoided for the same reason as the patient is thus exposed to a more severe infection. As the body's immune response is modified during therapy, the patient is not only exposed to viral and bacterial but also fungal infections, the course of which may be atypical. Occasionally, symptoms of infection are masked during corticosteroid therapy and are not treated properly.
As already mentioned, the secretory capacity of the adrenal cortex is controlled by the hypothalamic-pituitary-adrenal cortex axis. During the use of hydrocortisone, the own secretion of corticosteroids may be impaired and this condition may persist for up to several months after treatment. Consult your doctor about how to stopa drug to reduce withdrawal symptoms (severe adrenal insufficiency, fever, muscle and joint pain, generalized malaise).
Systemic corticosteroids should be administered under strict medical supervision to patients suffering from:
- ulcerative gastroduodenitis
- osteoporosis
- hypertension
- congestive heart failure
- diabetes
- ongoing or history of manic-depressive psychosis
- history of tuberculosis
- glaucoma
- liver damage or cirrhosis
- kidney failure
- epilepsy
- history of thrombophlebitis
- intestinal diverticulosis
- myasthenia gravis
- eye herpes
- hypothyroidism.
The risk of rupture of the left ventricle wall after the use of hydrocortisone tablets in patients after myocardial infarction has been noticed. The risk of treatment in such a patient should be considered.
Long-term therapy with medium and high doses of hydrocortisone can lead to hypertension, in addition, the concentration of sodium and water retention in the body increases (a diet low in sodium is recommended by specialists).
During the therapy, there is an excessive loss of potassium in the urine, therefore the doctor usually prescribes the patient a drug supplementing potassium in the body or its supplementation with OTC.
A danger for menopausal women and the elderlywho have been prescribed hydrocortisone treatment by a doctor is the increased loss of calcium from the bones. This can lead to osteoporosis in these patient groups. This does not mean that only these people are at risk of losing calcium. All corticosteroids cause bone demineralization, so it is important to check with your doctor and take calcium supplements.
The therapy may aggravate the symptoms of diabetes or reveal diabetes in the patient.
In women, menstrual disorders are sometimes observed during the use of systemic hydrocortisol therapy.
Possible interactions of hydrocortisone with drugs
Take hydrocortisone with caution from:
- acetylsalicylic acid and non-steroidal anti-inflammatory drugs - increased risk of gastrointestinal bleeding and ulceration, additionally, salicylate poisoning may occur
- phenytoin, ephedrine, carbamazepine, barbiturates, rifampicin, primidone, sympathomimetics, amidoglutethimide - they reduce the activity of hydrocortisone in the body
- with ketoconazole - the use of ketoconazole with hydrocortisone may lead to adrenal insufficiency during steroid withdrawal
- drugsdiuretics that increase potassium excretion - there is a risk of hypokalaemia
- drugs for hypertension - these drugs are less effective with the simultaneous administration of hydrocortisone
- cardiac glycosides, theophylline, beta2-sympathomimetics, amphoteric - increased risk of hypokalemia
- antidiabetic drugs - hydrocortisone reduces their effectiveness
- methotrexate - increase in haematological toxicity.
Use of hydrocortisone during pregnancy and nursing mothers
Doctors agree that hydrocortisol therapy should be undertaken in a pregnant woman only if necessary and after assessing the risk-benefit ratio of the therapy. Hydrocortisone crosses the placenta. A pregnant woman should not make her own treatment decisions without consulting a doctor.
Hydrocortisone also passes into breast milk and may disrupt the release of endogenous glucocorticosteroids in the baby. The best solution is to take a break from breastfeeding during treatment.
Hytdrocortisone in children and adolescents
Hydrocortisone should be used with caution in children. Children have a greater body surface area to weight ratio than adults. The result is that even skin absorption of corticosteroid can suppress the action of the hypothalamic-pituitary-adrenal axis. There may be characteristic side effects as well as growth and development disorders. Treatment of children should be under the close supervision of a specialist.
Hydrocortisone - side effects
Hydrocortisone can cause side effects the nature of which varies, among other things. on the method of administering the drug.
Side effects after topical application of hydrocortisone:
- skin and subcutaneous tissue disorders such as atrophic dermatitis, folliculitis, contact allergy, periocular inflammation, hirsutism, delayed wound or ulcer healing, ecchymosis, stretch marks, posteroid purpura, posteroid acne, dermatitis perioralis, burning , redness, excessive dryness
- infections and infestations including viral, bacterial and fungal origin
- superficial vasodilation and ecchymosis
- glaucoma or cataracts.
Side effects after systemic use of hydrocortisone:
- infections and parasitic infestations, including masking the symptoms of such or its severity
- blood and lymphatic system disorders such as: leukocytosis, thrombocytopenia, lymphopenia
- anaphylactic reactions
- endocrine disorders such as disordersmenstruation, Cushing's syndrome, growth retardation in children, reduced carbohydrate tolerance, the aforementioned suppression of the hypothalamic-pituitary-adrenal axis, increased insulin requirements, emergence of diabetes or worsening of existing symptoms
- increased protein catabolism
- mental disorders that patients should be informed about, especially those with a history of manic-depressive disorders, symptoms include headache, dizziness, hallucinations, psychosis, euphoria, mood changes
- seizures
- neuritis
- visual disturbance, glaucoma, blurred vision, increased intraocular pressure
- cardiac disorders such as arrhythmias, ECG changes, fainting, worsening of hypertension especially in patients with already existing high blood pressure, hypertrophic cardiomyopathy in premature babies
- thromboembolism, fatty embolism, hypercholesterolaemia, atherosclerosis, thrombophlebitis, necrotizing vasculitis
- nausea, vomiting, gastric irritation, esophagitis, ulceration, ulcer perforation and bleeding.