Hydrocortisone cream is the mildest topical steroid, used for eczema, dermatitis, insect bites and itchy rashes. Because it is gentle it is the one steroid suitable for the face, for skin folds and for children — and it is available from a pharmacy without a prescription at 1%.
What is Hydrocortisone?
The South African Medicine Price Registry lists hydrocortisone in several forms:
| Product | Schedule | Form | Contains |
|---|---|---|---|
| Vari-Hydrocortisone, Biocort, Stopitch | S2 | Cream | Hydrocortisone 1% (10 mg/g) |
| Neoderm | S4 | Cream | Hydrocortisone with neomycin |
| Terracortril | S4 | Ointment | Hydrocortisone with oxytetracycline and polymyxin B |
| Viocort | S4 | Cream | Hydrocortisone with chlorobutanol and diiodohydroxyquinoline |
| Solu-Cortef, Macleods hydrocortisone | S4 | Injection | Hydrocortisone 100 mg |
Plain 1% cream is Schedule 2 — available from a pharmacy without a prescription. The combination products, which add an antibiotic or antiseptic, are Schedule 4 and require one. Check which you have, because a combination product is not a general-purpose itch cream.
The injection is an entirely different use: it is given in hospital for severe allergic reactions, asthma attacks, and adrenal crisis. Nothing on this page about creams applies to it.
Hydrocortisone is a corticosteroid — a synthetic version of cortisol, the hormone your adrenal glands produce. Applied to skin it switches off the local inflammatory response, reducing redness, swelling and, most usefully, the itch that drives scratching and keeps rashes going.
It sits at the bottom of the potency scale, and that is precisely its value. Mild means it can be used where stronger steroids cause lasting damage: the face, the eyelids, skin folds, and children’s skin.
What is Hydrocortisone commonly used for?
- Mild to moderate eczema and atopic dermatitis, particularly on the face and in folds.
- Contact dermatitis — reactions to jewellery, detergents, cosmetics, plants.
- Insect bites and stings with an itchy inflammatory reaction.
- Mild allergic skin rashes.
- Irritant dermatitis, including hand dermatitis from frequent washing.
- Nappy rash, in some prescribing and briefly.
- Seborrhoeic dermatitis, on advice.
- Itchy rashes where the cause is known and is not infection.
Two things it does not do:
It does not treat infection. Hydrocortisone contains no antibiotic or antifungal. On a fungal rash it calms the redness while the fungus spreads. On bacterially infected skin it can make things worse.
It does not cure eczema. It settles a flare. What reduces how often flares happen is emollients used every day, including when the skin looks well. That is the treatment that does the long-term work, and it is the one most often neglected.
When to stop assuming and start asking: if a rash needs hydrocortisone repeatedly, or is not settling within a week or two, it needs a diagnosis rather than another tube.
How Hydrocortisone fits into this medicine category
| Potency | Examples | Typical use |
|---|---|---|
| Mild | Hydrocortisone 1% | Face, folds, children, mild eczema |
| Moderate | Clobetasone butyrate | Moderate eczema; delicate sites briefly |
| Potent | Betamethasone (Clomaderm), methylprednisolone aceponate | Moderate to severe eczema, dermatitis |
| Very potent | Clobetasol propionate | Severe or resistant conditions, specialist use |
| Antifungals | Clotrimazole (Canex V) | Fungal infection |
| Emollients | Emulsifying ointment, aqueous cream | Daily barrier care — the long-term treatment |
Using a potent steroid where a mild one would do, or a mild one where a flare needs more, are both common errors. See the skin and wound care hub.
What to check before using Hydrocortisone
Speak to a pharmacist or doctor if:
- The rash may be fungal — ringworm, athlete’s foot, thrush in a fold, or a rash with a defined spreading edge and clearer centre.
- The skin is broken, weeping, crusted, blistered or pustular, or there is spreading redness, heat or fever.
- The rash may be viral — cold sores, shingles, chickenpox.
- You are treating acne, rosacea or perioral dermatitis, which steroids worsen.
- You are treating around the eyes, which needs medical advice.
- You are treating a child under 10, or a baby, without advice.
- You are pregnant or breastfeeding. If used on the breast, wash it off before feeding.
- The rash has never been diagnosed, or is not improving.
Using it properly:
- Apply a thin layer once or twice daily to affected areas only.
- Use the fingertip unit as a guide — one adult fingertip covers about two adult palms.
- Do not use it for more than a week on the face, or two weeks elsewhere, without advice.
- Do not cover with an airtight dressing unless told to.
- Keep using your emollient, leaving fifteen to twenty minutes between the two.
- Wash your hands afterwards unless treating them.
Possible cautions and when to ask a pharmacist or doctor
Used briefly and correctly, hydrocortisone 1% is one of the safest medicines in a pharmacy — and under-treating a flare out of fear of steroids causes its own harm through sleepless scratching, broken skin and infection.
Side effects are uncommon at this strength and mostly follow prolonged use: skin thinning, perioral dermatitis around the mouth, worsening of untreated infection, and burning or stinging on application.
Stop and seek advice if the skin becomes thinner or shinier, if the rash worsens rather than settles, or if the treated area becomes more irritated.
Get emergency help for swelling of the face, lips or tongue, difficulty breathing, or a rapidly spreading blistering rash.
Contact your doctor if:
- The rash is not improving after a week, or returns as soon as you stop.
- The skin becomes weeping, crusted, hot or painful, or you develop a fever.
- Small blisters, punched-out sores or rapidly spreading painful lesions appear on eczema — this can be eczema herpeticum, needing urgent antiviral treatment.
- You are using it most weeks, which means the underlying condition needs a proper plan.
- Eczema is disturbing sleep, in a child or an adult.
- A child’s rash is spreading, or the child is unwell.
Related medicine guides
Frequently asked questions
What is hydrocortisone cream used for? Mild eczema, dermatitis, contact reactions, insect bites and itchy rashes. It reduces redness, swelling and itch.
Can I use hydrocortisone cream on my face? Hydrocortisone 1% is the one steroid strength generally considered suitable for the face — but use it briefly, up to about a week, and get advice if the rash is not settling or is near the eyes.
Do I need a prescription? Plain 1% cream is Schedule 2 and available from a pharmacy without one. Combination products with an antibiotic are Schedule 4 and need a prescription.
Can I use it on ringworm or athlete’s foot? No. It contains no antifungal, and the steroid lets the fungus spread while masking the redness.
How long can I use it? Up to about a week on the face and two weeks elsewhere. Longer use should be supervised.
Can I use it on my baby? Ask a pharmacist, clinic nurse or doctor first. It is used in children, but young skin absorbs more relative to body size.
Is it strong enough for bad eczema? Often not. A moderate or potent steroid may be needed for a significant flare — that is a conversation with a doctor rather than a reason to use more hydrocortisone.
Do I still need moisturiser? Yes. Daily emollients are what reduce how often flares happen.