Hydrocortisone ointment 1% (POM)

Hydrocortisone has topical anti-inflammatory activity of value in the treatment of a wide variety of dermatological conditions, including the following:

• eczema – atopic, infantile, discoid, stasis

• dermatitis - primary irritant, contact allergic, photo or seborrheic

• prurigo nodularis

• neurodermatoses

• otitis externa

• intertrigo

• insect bite reactions

• napkin rash, where concurrent infection is excluded or being addressed.

Posology

Adults and elderly: Apply, once to four times daily gradually increasing the intervals between applications as the condition improves. Treatment may then be reduced to two to three times a week or when symptoms recur. Gentle massage assists penetration. The same dose is used for adults and the elderly, as clinical evidence would indicate that no special dosage regimen is necessary in the elderly.

Children and infants: Gently apply a thin layer of ointment to the affected area(s) two or three times a day. Long term therapy should be avoided and where possible limited to five to seven days.

Method of administration

For cutaneous use only.

• Hypersensitivity to the active substance(s) or to any of the excipients listed in section 6.1.

• Use on untreated bacterial (e.g. impetigo), fungal (e.g. candida or dermatophyte) or viral (e.g. herpes simplex) infections of the skin, infected lesions, ulcerative conditions, rosacea, peri-oral dermatitis or acne.

The label will state mild steroid.

Visual disturbance:

Visual disturbance may be reported with systemic and topical corticosteroid use. If a patient presents with symptoms such as blurred vision or other visual disturbances, the patient should be considered for referral to an ophthalmologist for evaluation of possible causes which may include cataract, glaucoma or rare diseases such as central serous chorioretinopathy (CSCR) which have been reported after use of systemic and topical corticosteroids.

Remarks on indications

1. There is no good evidence that topical corticosteroids are efficacious against immediate (Type 1) allergic skin reactions or short-lived weal and flare reactions from other causes.

2. Topical corticosteroids are ineffective in granulomatous conditions and other inflammatory reactions involving the deeper regions of the dermis.

3. Topical corticosteroids are not generally indicated in psoriasis excluding widespread plaque psoriasis provided that warnings are given.

In infants and children, long-term treatment should be avoided especially on the face as adrenal suppression can occur.

Topical corticosteroids may be hazardous in psoriasis for a number of reasons including rebound relapses following development tolerance, the risk of generalised pustular psoriasis and local and systemic toxicity due to impaired barrier function of the skin; careful patient supervision is important.

Although generally regarded as safe, even for long-term administration in adults, there is potential for adverse effects if overused in infancy. Extreme caution is required in dermatoses of infancy, including napkin eruption. In such patients, courses of treatment should not normally exceed seven days.

Appropriate antimicrobial therapy should be used treating inflammatory lesions which have become infected. Any spread of infection requires withdrawal of topical corticosteroid therapy, and systemic administration of antimicrobial agents.

Topical steroid withdrawal syndrome

Long term use of topical steroids can result in the development of rebound flares after stopping treatment (topical steroid withdrawal syndrome). A severe form of rebound flare can develop which takes the form of a dermatitis with intense redness, stinging and burning that can spread beyond the initial treatment area. It is more likely to occur when delicate skin sites such as the face and flexures are treated. Should there be a reoccurrence of the condition within days to weeks after successful treatment a withdrawal reaction should be suspected. Reapplication should be with caution and specialist advise is recommended in these cases or other treatment options should be considered.

In infants and children particularly, care should be taken that the lowest strength of hydrocortisone ointment that is clinically effective is used. The 2.5% strength is normally only necessary in the more severe cases and is better avoided in infants.

The use of an occlusive dressing can considerably increase the degree of systemic absorption.

As with all corticosteroids, application to the face may damage the skin and should be avoided. Caution should be taken to keep away from the eyes.

Healthcare professionals should be aware that if the product comes into contact with dressing, clothing and bedding, the fabric can be easily ignited with a naked flame.

Patients should be warned of this risk and advised to keep away from fire when using this product.

None known

Pregnancy

There is inadequate evidence of safety in human pregnancy. Topical administration of corticosteroids to pregnant animals can cause abnormalities of foetal development including cleft palate and intra-uterine growth retardation. Therefore there be a small risk of such events in the human foetus. There is a theoretical risk of such effects on the human foetus.

Breast-feeding

There is no evidence against use in lactating women. However, caution should be exercised when hydrocortisone ointment is administered to nursing mothers. In this event, the product should not be applied to the chest area. There is theoretical risk of infant adrenal function impairment if maternal systemic absorption occurs.

None known

Treatment with hydrocortisone ointment is usually well tolerated but treatment should be stopped immediately if symptoms of hypersensitivity occur.

Epidermal thinning, telangiectasia and striae may occur in areas of high absorption such as skin folds, the face and where occlusive dressings are used. Local atrophic changes may occur in intertriginous areas or in nappy areas in young children where moist conditions favour hydrocortisone absorption.

Following prolonged topical use systemic absorption from sites may be sufficient to produce hypercorticism and suppression of the pituitary adrenal axis after prolonged treatment. This effect is more likely to occur in infants and children and if occlusive dressings are used or large areas of skin are treated.

Eye disorders:

Frequency not known: Vision, blurred (see section 4.4).

Skin and Subcutaneous Tissue Disorders

Not known (cannot be estimated from available data) Withdrawal reactions - redness of the skin which may extend to areas beyond the initial affected area, burning or stinging sensation, itch, skin peeling, oozing pustules. (see section 4.4).

Reporting of suspected adverse reactions

Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.

Excessive use under occlusive dressings may produce adrenal suppression. No special procedures or antidote. Treat any adverse effects symptomatically. Acute overdosage is very unlikely to occur. In the case of chronic overdosage or misuse the features of hypercorticism may appear and in this situation, topical steroids should be discontinued.

Pharmacotherapeutic group: Corticosteroids, weak (group I), ATC code: D07AA02.

Hydrocortisone 1% is classed as a mild corticosteroid.

Your healthcare professional will prescribe or advise a steroid of the appropriate potency for your condition.

Hydrocortisone is an anti-inflammatory steroid. Its anti-inflammatory action is due to reduction of the vascular component of the inflammatory response and reduction of the formation of inflammatory fluid and cellular exudates. The granulation reaction is also decreased due to the inhibition effect of hydrocortisone on connective tissue. Stabilisation of most cell granules and lysomal membranes decreases the mediators involved in inflammatory response and reduces release of enzymes involved in prostaglandin synthesis. The vasoconstrictor action of hydrocortisone may also contribute to its anti-inflammatory activity.

Absorption: Topically applied steroids are absorbed to a significant extent only if applied to broken skin, to very large areas or under occlusive dressings.

Distribution: Corticosteroids are rapidly distributed to all body tissues. They cross the placenta and may be excreted in small amounts in breast milk.

Metabolism: Hydrocortisone is metabolised mainly in the liver, but also the kidney, to various degraded and hydrogenated forms such as tetrahydrocortisone.

Elimination: Hydrocortisone is excreted in the urine, mostly conjugated as glucuronides. Only very small amounts of unchanged hydrocortisone are excreted.

Adverse effects of hydrocortisone are due to its effects on electrolyte balance, metabolism and particularly adrenal suppression. Topical use of hydrocortisone has only rarely been associated with systemic side effects.

Wool fat

Liquid Paraffin

White Soft Paraffin

None known

60 Months

Do not Store above 25° C

A collapsible aluminium tube, with a membrane seal at the nozzle, internal epoxy lacquer, latex end seal band in the crimp seal area and a white plastic cap for re closure after piercing membrane.

Pack Size 10g,15g, 30g and 50g. Not all pack sizes may be marketed.

No special precautions are required