Why you shouldn’t put hydrocortisone on your face for too long
[I'm going to purge some old post drafts over the next couple of days.]
At the beginning of the summer, I had a spat of illness, including the flu, persistent coughing, and a rash.
Let’s talk about the rash, since such things are always so topical. I had pink skin peppered with red bumps on the lower left side of my face, and it was super itchy. So I decided to put some hydrocortisone on it, right?
Apparently not. My tube of cream says “Do not use on the face except if advised by a doctor”, which seemed a little mysterious to me. But here’s why:
- Hydrocortisone can thin the skin and brings capillaries to the surface (if prescription-strength and/or used for more than a few days at a time). On your leg, capillaries under thin skin isn’t so bad, but on your face, it can be unsightly. ((Explanation, and “Prominent capillaries” picture near bottom of http://dermnetnz.org/treatments/topical-steroids.html))
- Steroids are absorbed much more easily on the face, and higher absorption can cause adrenal gland suppression or Cushing’s syndrome. ((http://dermnetnz.org/treatments/topical-steroids.html))
When topical hydrocortisone was approved for over-the-counter sale, the use of a steroid on delicate facial skin was not considered an appropriate indication. Long-term and/or high strength steroids can damage the skin (1,2), and on the face this would be particularly noticeable. These problems have not been demonstrated with short-term OTC hydrocortisone, but form a theoretical basis for caution. In addition to this, some common skin conditions affecting the face can be caused or made worse by hydrocortisone (eg impetigo, rosacea, and acne) (1,2). Therefore all over-the-counter hydrocortisone creams and ointments have “use on the face” as a contra-indication, and pharmacists are not allowed to sell them for this purpose.
Patients with skin conditions affecting the face ought to see their GP first, rather than self-medicating. GPs can prescribe hydrocortisone for use on the face, having first assessed the appropriateness of doing so.
My doctor ended up telling me I could use the over-the-counter stuff on my face, if I only needed it for a few days. (“It’s the prescription stuff you really have to worry about.”)