Hydrocortisone 1% cream is one of the most frequently requested OTC medicines in UK pharmacies. As a mild topical corticosteroid, it is effective for a range of inflammatory skin conditions — but it is also one of the most commonly misused, applied to conditions where it can worsen the problem or mask a diagnosis that needs medical attention.

What OTC hydrocortisone is licensed for

Hydrocortisone 1% cream is available as a P (pharmacy) medicine for the following indications in adults and children aged 10 years and over:

• Mild to moderate eczema (atopic dermatitis) — short-term relief of flares
• Contact dermatitis — irritant or allergic, including nickel allergy
• Insect bite reactions — reducing inflammation and itch after the acute sting
• Mild inflammatory skin reactions — including mild sunburn inflammation

For children aged 2–10 years, some branded products are licensed for insect bites and stings only. Always check the individual product licence, as this varies between brands.

Under 2 years: Not available OTC. Prescription required.

How to use it correctly

According to BNF guidance on topical corticosteroids:

• Apply thinly to the affected area only, once or twice daily.
• Duration: Maximum seven days for OTC use. If symptoms have not improved within seven days, the patient should see a GP.
• Fingertip unit (FTU): One FTU (from the tip of an adult index finger to the first crease) covers an area approximately the size of two adult palms. This helps patients apply the right amount — many under-apply, reducing effectiveness.
• Apply after emollient. Wait at least 10–30 minutes after applying a leave-on emollient before applying hydrocortisone, or apply the emollient first and the steroid on top once the emollient has absorbed.

Where NOT to apply it

This is where pharmacy counselling adds the most value. OTC hydrocortisone should not be applied to:

• The face — facial skin is thin and highly vascular, making it more susceptible to steroid side effects including telangiectasia (visible blood vessels), perioral dermatitis and skin thinning. Facial use requires GP supervision.
• Broken or infected skin — steroids suppress local immune function and can worsen bacterial, viral or fungal infections.
• The ano-genital area — unless specifically directed by a prescriber.
• Under occlusion (tight bandages or nappies) — increases absorption significantly.
• Large areas of the body — OTC use is intended for localised patches only.

What it does NOT treat

Several common conditions brought to the pharmacy counter look superficially suitable for hydrocortisone but are actually worsened by it:

Fungal infections

Ringworm (tinea corporis), athlete's foot and fungal groin rash can present with red, itchy, scaly patches that patients assume are eczema. Applying hydrocortisone suppresses the inflammation and initially appears to help, but the fungal infection spreads unchecked — a phenomenon dermatologists call "tinea incognito." The modified rash then becomes harder to diagnose.

Pharmacy tip: A ring-shaped, spreading lesion with a clearing centre is characteristic of ringworm, not eczema. Recommend a topical antifungal (clotrimazole, miconazole or terbinafine) instead.

Acne

Hydrocortisone may temporarily reduce the redness of acne lesions, but steroid use on acne-prone skin can trigger or worsen steroid acne and perioral dermatitis. It is not indicated for acne.

Rosacea

Rosacea on the cheeks and nose can resemble eczema, but topical steroids worsen rosacea and can cause steroid-induced rosacea with rebound flares on withdrawal. Refer for GP assessment.

Impetigo and other skin infections

The golden-crusted lesions of impetigo require antibacterial treatment (fusidic acid or oral antibiotics), not anti-inflammatory suppression.

Side effects and risks

With short-term OTC use (seven days or fewer) on appropriate body areas, side effects are rare. However, pharmacists should be aware of the risks of prolonged or inappropriate use:

• Skin thinning (atrophy) — particularly on the face, neck and flexures
• Striae — stretch marks, especially in skin folds
• Telangiectasia — visible small blood vessels
• Contact sensitisation — allergic reaction to the cream base or preservatives
• Rebound flare — worsening of the original condition after stopping, particularly with prolonged use on the face

Common patient questions

"Can I use it on my baby's eczema?" Not OTC — hydrocortisone for children under 2 requires a prescription. Recommend an emollient and a GP appointment.

"Can I use it every day for my eczema?" OTC hydrocortisone is for short-term flare management only (up to 7 days). Patients needing regular steroid use should be under GP care with a treatment plan that may include steroid-free intervals and emollient maintenance.

"Is it safe in pregnancy?" According to BNF guidance, mild topical corticosteroids may be used in pregnancy on small areas for short periods. However, pharmacists should advise pregnant women to check with their midwife or GP if unsure.

Finding pharmacy skin advice

Community pharmacists can assess and recommend treatments for many common skin conditions without a GP appointment. Use PharmSee's pharmacy finder to locate a pharmacy near you, or explore pharmacy careers in dermatology-focused roles.

Sources: BNF Hydrocortisone (topical), NICE CKS Topical Corticosteroids, EMC product SmPCs.