Written for Stock My Medicine and clinically reviewed by Hajra Dhanchora, MPharm (GPhC 2216990).
Hydrocortisone cream is the mildest steroid cream there is, and the one you can buy without a prescription. It is very good at what it does, which is calming an itchy, inflamed patch of skin within a day or two. It is also widely misused: on faces, on fungal rashes, and for weeks at a time. Here's what it's actually for, how to use it properly, and when a different cream is the right answer.
What is hydrocortisone cream used for?
The 1% cream sold in pharmacies is licensed for mild to moderate eczema, contact and irritant dermatitis (the reaction to a watch strap, a detergent, a plant or a new pair of earrings), and the itchy, swollen reaction to insect bites and stings. It's for small areas, for short bursts, in adults and children aged 10 and over. GPs prescribe the same ingredient in stronger forms and for longer, including for children under 10, which is where much of the confusion comes from.
Is hydrocortisone cream a steroid, and what does it do?
Yes, a corticosteroid, the same family as the hormone cortisol that your body makes, and nothing to do with the anabolic steroids of gym rumour. Applied to the skin it turns down the local immune response that causes redness, swelling and itch. It doesn't moisturise, it doesn't kill anything, and it doesn't treat the cause; it settles the inflammation while the cause is removed. Steroid creams come in four strengths, and hydrocortisone 1% is in the mildest class, which is why it's the only one you can buy. It usually starts working within a day and the rash should be clearly better within three.
How to use it: the fingertip unit
Apply a thin layer once or twice a day to the affected skin only, rubbed in gently, after any moisturiser has soaked in (leave about 30 minutes between the two). The standard measure is the fingertip unit: cream squeezed along an adult index finger from the tip to the first crease, about half a gram, which covers an area twice the size of a flat adult hand. For a bite or a patch of eczema on the arm that's usually a fraction of a fingertip. Wash your hands afterwards unless the hands are what you're treating.
| Area being treated | Fingertip units per application |
|---|---|
| One hand, front and back | 1 |
| One whole arm | 3 |
| One foot | 2 |
| One whole leg | 6 |
| Front or back of the trunk | 7 |
Those larger areas are for prescribed use; the pharmacy cream is meant for small patches, and if you need whole limbs covered you need a GP.
How long can you use hydrocortisone cream?
Seven days at a time without advice. That's not an arbitrary number: used continuously for weeks, steroid creams thin the skin, cause stretch marks and visible small blood vessels, and can lighten the skin, and a rash that needs more than a week of hydrocortisone needs a proper look rather than more cream. If it's clearly better, stop; if it's not better after seven days, see a pharmacist or GP. Used correctly, for a week here and there, none of those side effects are a realistic worry, and stopping after a short course doesn't cause a rebound.
Can I use hydrocortisone cream on my face? The places it must not go
Not without a doctor's say-so. Facial skin is thin and shows steroid damage first, and hydrocortisone near the eyes can raise the pressure inside them. The other no-go areas on the pharmacy pack are the genitals and anus, broken or infected skin, and anything that isn't simple inflammation: acne, rosacea, cold sores, impetigo, chickenpox, and athlete's foot, ringworm or thrush on their own. That last group matters because a steroid feeds a fungal infection by switching off the defence against it; the rash looks calmer for a few days, then spreads. If you're treating acne, our benzoyl peroxide guide is the right place.
When a combination cream is the right choice
When a fungal rash is red, angry and itchy, a cream that pairs hydrocortisone with an antifungal deals with both at once for the first week. Canesten Hydrocortisone combines clotrimazole with 1% hydrocortisone for inflamed athlete's foot and fungal skin rashes; Daktacort pairs miconazole with hydrocortisone for inflamed athlete's foot and sweat rash in skin folds. Both are for ages 10 and over, for seven days, after which you switch to the plain antifungal until the infection has fully cleared. For piles, Anusol Plus HC ointment and suppositories add hydrocortisone to the soothing base, for adults over 18 and again for a week at most. These are pharmacy medicines, so expect a couple of questions at checkout.
Eczema: the cream is the flare treatment, not the routine
For eczema, hydrocortisone is what you reach for during a flare. The daily work is done by emollients, generously and often, which repair the skin barrier and reduce how many flares you get: Cetraben, E45 and Aveeno Dermexa are all in our eczema range. Use the emollient as a soap substitute too. If flares are coming more than every few weeks, or hydrocortisone isn't holding them, a GP can prescribe the next strength up and check for triggers.
Pregnancy, breastfeeding, children and other medicines
In pregnancy, small amounts on small areas for a few days are considered safe, but check with a pharmacist first and don't use it on the breasts if breastfeeding without washing it off before a feed. Children under 10 should only use it on a pharmacist's or doctor's advice. Hydrocortisone cream doesn't interact with tablets you take by mouth, and it's fine to take an antihistamine for the itch at the same time; if a bite is intensely itchy, that pairing works well. Tell your pharmacist if you're already using another steroid cream or a steroid inhaler, simply so the total is kept sensible.
When to see a GP
See a GP if the rash isn't improving after seven days, if it's spreading, weeping, crusting or hot (signs it's infected), if it's on the face or genitals, if it covers a large area, if it keeps coming back in the same place, or if you're not sure what the rash is. A rash with a fever, or one that doesn't fade when a glass is pressed on it, needs urgent help. Our pharmacist can look at a photo and tell you whether hydrocortisone, an antifungal, an emollient or a GP is the right next step.
Frequently asked questions
Can you buy hydrocortisone cream over the counter?
Yes, the 1% cream and ointment are pharmacy medicines for adults and children over 10. Stronger steroids and use on the face or in young children need a prescription.
Cream or ointment?
Cream for weepy or moist patches and skin folds; ointment for dry, scaly, thickened skin, because the greasy base holds moisture in. The dose is the same.
Can I use hydrocortisone cream on a sunburn?
Not on blistered or broken skin. For simple red sunburn, cool it, moisturise it and take ibuprofen; hydrocortisone adds little.