Hydrocortisone (topical) for eczema

Name of medicine

Hydrocortisone

Brand names: Dioderm®, Mildison®

This leaflet is about the use of hydrocortisone cream and ointment for the treatment of eczema. This is called topical treatment, meaning that it is applied to the skin.

Why is it important for my child to take hydrocortisone?

Hydrocortisone cream or ointment helps to reduce the inflammation of eczema and so will reduce the redness and itchiness of your child’s skin.

Your doctor will prescribe a short course of treatment. The cream/ointment should be applied regularly during this time.

What is hydrocortisone available as?

Ointment: 0.5%, 1%, 2.5%

Cream: 0.1%, 0.5%, 1%, 2.5%; these may contain alcohol

When should I give hydrocortisone

Hydrocortisone cream/ointment is usually applied once each day. This can be in the morning OR the evening.

Your doctor may suggest that you use the cream/ointment twice each day. This should be once in the morning and once in the evening. Ideally, these times are 10–12 hours apart, for example some time between 7 and 8 am, and between 7 and 8 pm.

Apply the cream/ointment at about the same time(s) each day so that this becomes part of your child’s daily routine, which will help you to remember. 

Hydrocortisone should not be applied at the same time as other creams or ointments, such as your child’s usual moisturiser or emollient. Wait at least 10 minutes between applying hydrocortisone and any other product. Ideally, apply different products at different times of the day.

How much should I give?

Your doctor will work out the amount of hydrocortisone cream/ ointment (the dose) that is right for your child. The dose will be shown on the medicine label

How should I give hydrocortisone?

Apply the cream/ointment to all areas of skin with eczema as your doctor or pharmacist has told you to. Do not apply it to skin that is not affected.

Squeeze out the right length of cream or ointment against your finger. Spread it in a thin layer over the entire affected area. Do not rub the cream/ointment hard into the skin as you may irritate the skin. If you are unsure about how much to use, talk to your pharmacist.

Wash your hands before and after applying the cream or ointment.

When should the medicine start working?

Your child’s skin should start to look better after you have been applying the cream/ointment for 3–7 days. You should continue to apply the cream regularly as directed by your doctor. If your child’s skin does not seem to be getting better, or seems worse, contact your doctor for advice. 

What if my child is sick (vomits)?

You do not need to worry, as the cream/ointment will still work.

What if I forget to give it?

If you usually apply it once a day in the morning

Apply the cream/ointment during the day when you remember, as long as this is at least 8 hours before the next application is due.

If you usually apply it once a day in the evening

You do not need to wake up a sleeping child up to apply the cream/ointment. You can apply it in the morning, as long as this is at least 8 hours before the evening application is due.

If you usually apply it twice a day

Apply the cream/ointment if you remember up to 4 hours after you should have done it. For example, if you usually apply the cream/ointment at 7 am, you can do it any time up to about 11 am. If you remember after that time, do not apply the missed dose. Wait until the next normal dose. 

What if I give too much?

It is unlikely that you will do harm if you apply a little too much cream or ointment. If you worried that you may have used too much, or have used it too often, contact your doctor local NHS services (111 in England and Scotland; 111 or 0845 4647 in parts of Wales). Have the tube or packaging with you if you telephone for advice.

Are there any possible side effects?

We use medicines to make our children better, but sometimes they have other effects that we don’t want (side-effects).

Your child is unlikely to get side-effects with hydrocortisone cream or ointment if you use it in the way that your doctor has told you to.

• Your child’s skin may seem redder when you first start to apply the cream/ointment.
• Your child may get spots on their skin.
• The cream/ointment may spread an untreated infection and make it worse. If your child’s skin becomes redder, has white patches or weeps yellow fluid, it may be infected. Take your child to their doctor, as this will need treatment. Do not apply any more cream/ointment.
• If the cream/ointment is used for a long period, there is a risk that the skin will become thinner, there may be some scarring and small blood vessels may become visible on the skin and areas of the skin may become darker.
• Sometimes the skin becomes lighter in colour, but should go back to normal when the treatment is finished.

Can other medicines be given at the same time as hydrocortisone?

• You can give your child medicines that contain paracetamol or ibuprofen, unless your doctor has told you not to.

Check with your doctor or pharmacist before giving any other medicines to your child. This includes herbal and complementary medicines.

Is there anything else I need to know about this medicine?

• Your child may be prescribed different strengths of hydrocortisone, for e.g. 1% and 2.5%, to be applied to different areas of skin with eczema. Do not switch or mix the strengths that you apply to each area, as this may cause harm.
• Keep the hydrocortisone cream/ointment away from your child’s eyes.
• Apply the cream/ointment to all areas of skin with eczema, not just to the worst-affected areas.
• If you are applying cream/ointment to large areas of skin or to skin that is damaged, there is a slight risk that it will be absorbed into the body and may affect your child’s growth. If your child needs frequent courses of strong steroid creams, your doctor will check their growth.
• Steroid creams and ointments such as hydrocortisone are only used for short periods of time, especially if used on the face.
• Wash your hands after applying the cream/ointment to your child’s skin.
• The use of steroids in children has received a lot of bad press. However, use of steroid cream/ointment in eczema provides a lot of benefit, and is unlikely to cause any long-term harm as long as you use the cream/ ointment as your doctor has told you to. If you are at all worried, talk to your doctor or pharmacist.

General advice about medicines

• Only give this medicine to your child. Never give it to anyone else, even if their condition appears to be the same, as this could do harm.

• If you think someone else may have taken the medicine by accident, contact your doctor for advice.

• Make sure that you always have enough medicine. Order a new prescription at least 2 weeks before you will run out.

• Make sure that the medicines you have at home have not reached the ‘best before’ or ‘use by’ date on the packaging. Give old medicines to your pharmacist to dispose of.

• Try to give medicines at about the same times each day, to help you remember.

Where should I keep this medicine?

• Keep the medicine in a cupboard, away from heat and direct sunlight.

• It does not need to be kept in the fridge.

• Make sure that children cannot see or reach the medicine.

• Keep the medicine in the container it came in.

Who to contact for more information?

Your doctor, pharmacist or nurse will be able to give you more information about hydrocortisone and about other medicines used to treat eczema.

Copyright disclaimer

Version [2]. © NPPG, RCPCH and WellChild, all rights reserved. Review by July 2013.

The primary source for the information in this leaflet is the British National Formulary for Children. For details on any other sources used for this leaflet, please contact us through our website, www.medicinesforchildren.org.uk.

We take great care to make sure that the information in this leaflet is correct and up-to-date. However, medicines can be used in different ways for different patients. It is important that you ask the advice of your doctor or pharmacist if you are not sure about something. This leaflet is about the use of these medicines in the UK, and may not apply to other countries. The Royal College of Paediatrics and Child Health (RCPCH), the Neonatal and Paediatric Pharmacists Group (NPPG), WellChild and the contributors and editors cannot be held responsible for the accuracy of information, omissions of information, or any actions that may be taken as a consequence of reading this leaflet.