Hydrocortisone is a synthetic form of the hormone cortisol. It can help treat inflammatory skin conditions, such as insect bites, rashes, and eczema.
In this article, we examine the research into hydrocortisone as a treatment for acne. We also outline the potential side effects of hydrocortisone and list some alternative treatment options for acne.
Hydrocortisone is a synthetic version of the hormone cortisol, which the body produces naturally. Cortisol helps regulate metabolism, blood pressure, and blood sugar levels. It also possesses powerful anti-inflammatory properties.
Hydrocortisone can help treat inflammatory skin conditions that cause redness, swelling, and itching.
Topical hydrocortisone is not a conventional acne treatment. It has no effect on acne-causing bacteria, so it cannot prevent breakouts. However, it could help improve the appearance of inflammatory acne.
In an early study, researchers compared the effectiveness of two topical acne treatments: one with hydrocortisone, and the other without it.
The participants applied one of the two treatments twice a day for the first 4 days of the study. They then applied the cream only at night for the remainder of the 3-month study period.
The group that used hydrocortisone had a greater reduction in acne lesions at the end of the first month. However, the difference was not statistically significant.
Other research suggests that hydrocortisone may be effective when people use it alongside conventional acne treatments.
Another early study investigated the effectiveness of various individual and combined acne treatments. It found that people who used 1% hydrocortisone in combination with benzoyl peroxide showed more significant improvements in their acne than those who used benzoyl peroxide alone.
The researchers also noted that hydrocortisone helped reduce the inflammatory effects of benzoyl peroxide.
The Food and Drug Administration (FDA) have approved hydrocortisone for the treatment of inflammatory skin conditions, such as eczema. However, the medication can lead to adverse skin-related side effects.
In a 2014 review article, researchers found evidence suggesting that improper use of topical corticosteroids could lead to the following:
- impaired wound healing
- decreased skin elasticity
- reduced skin thickness
The researchers also cited several cases in which topical corticosteroid use contributed to either noninflammatory or inflammatory acne.
Hydrocortisone reduces inflammation. However, it has no direct effect on sebum production and does not kill acne-causing bacteria. As a result, hydrocortisone may have little to no effect on noninflamed pimples.
Cystic acne is a severe type of acne that involves infected and inflamed skin lesions.
Retinoids and antibiotics effectively address the underlying causes of cystic acne. A person may also take hydrocortisone to help reduce inflammation during an active breakout.
According to a 2014 review, oral corticosteroids offer temporary benefits during the initial treatment of inflammatory-type acne. However, the authors advise against using topical corticosteroids for treating acne.
According to the National Library of Medicine, hydrocortisone may help reduce scarring. However, it is not clear whether hydrocortisone can minimize acne scars, specifically.
A small 2017 study suggests that a similar synthetic corticosteroid called methylprednisolone may help prevent postsurgical scarring.
The study compared two different treatments: a cream containing methylprednisolone and a topical silicone gel. Following surgery, the participants who used the corticosteroid cream showed less severe scarring than those who used the silicone gel.
Hydrocortisone comes in many forms, including:
- topical ointments
- oral tablets
Over-the-counter (OTC) and prescription-strength hydrocortisone products come with recommendations on dosage and treatment duration. The recommendations can vary among manufacturers, so it is important that people follow the instructions on the packet or prescription.
There are no specific dosage instructions when using hydrocortisone as an acne treatment. As such, the following list includes general dosage information for different hydrocortisone treatments:
|Prescription topical cream||1% hydrocortisone: 1 mg of hydrocortisone per 1 g of product||Apply a thin layer to affected skin 2–3 times a day.||Discontinue use after 2 weeks if skin does not improve. Discontinue use after 4 weeks if treatment produces noticeable benefits.|
|OTC topical cream||0.5% hydrocortisone||Apply a thin layer to affected skin 3–4 times a day. Suitable for adults and children aged 2 years and above.||Discontinue use after 1 week. Discontinue use and do not use any other hydrocortisone products if symptoms continue for more than 1 week or return within a few days.|
|Oral tablet||5, 10, or 20 mg tablets||Take prescribed dosage (20–240 mg per day) by mouth.||Varies depending on the condition and the person’s response. Follow a doctor’s advice.|
In general, doctors consider hydrocortisone a safe and effective treatment for certain inflammatory conditions, such as eczema.
However, oral hydrocortisone can impair immune system function and increase a person’s risk of infections.
Hydrocortisone is not suitable for the following people:
- women who are pregnant or breastfeeding
- young children
- people taking birth control pills, anticoagulants, or aspirin
- people who have a history of liver, kidney, or heart disease
Everyone’s skin reacts differently. Topical hydrocortisone may help relieve skin redness, itching, and swelling in some people but cause negative skin reactions in others.
Some potential side effects of topical hydrocortisone include:
- skin irritation or dryness
- a rash of small red or white bumps
- worsening acne
- changes in skin pigmentation
- unwanted hair growth
Hydrocortisone can affect numerous organ systems besides the skin. Some of the more widespread, or systemic, side effects of hydrocortisone include:
- weight gain
- hormonal imbalances
- irregular menstrual periods
- impaired wound healing
- fragile skin
- increased sweating
- electrolyte imbalance
- fluid retention
- muscle weakness
- gastric ulcers
- high blood pressure, or hypertension
- Kaposi sarcoma
- tumors in the adrenal cortex
Some of the psychological side effects associated with oral hydrocortisone include:
There are a number of OTC and prescription treatments that people can use as an alternative to hydrocortisone. Treatments that manufacturers have specifically designed to treat acne may provide the best results.
Topical acne treatments include:
- salicylic acid
- benzoyl peroxide
- topical antibiotic ointments
Oral acne medications include:
- hormonal contraceptives
- androgen-suppressing hormones
People who are using hydrocortisone to treat acne should contact their doctor if they experience persistent or worsening side effects, such as:
- acne breakouts
- increased sweating
- difficulty sleeping
People who have severe cystic acne that does not respond to OTC treatments may wish to see a doctor or dermatologist for further evaluation. These healthcare professionals can prescribe stronger topical or oral medications for severe forms of acne.
Severe acne can significantly affect a person’s self-esteem and quality of life. While OTC and prescription strength medications can help treat and prevent acne breakouts, there are several ways in which people can manage their acne symptoms at home. These include:
- washing the face gently twice a day
- avoiding excessive washing or exfoliating of the face
- applying an oil-free moisturizer daily
- wearing a noncomedogenic sunscreen
- removing all makeup before going to bed
- resisting the urge to pop, squeeze, or pick at active blemishes
- avoiding touching the face
Hydrocortisone is a synthetic corticosteroid that helps reduce inflammation. It can minimize the redness and swelling of inflammatory acne. However, it does not treat the underlying causes of acne, which are excess sebum production and bacterial infection.
Hydrocortisone can cause both physical and psychological side effects. It also has the potential to make acne worse. People should consult a doctor or a licensed dermatologist before using hydrocortisone for acne.