Topical hydrocortisone

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Topical hydrocortisone
Cortisol2.svg
Clinical data
Trade names Ala-Cort, Aquanil HC, Beta HC, others [1]
Other namesCortisol; 11β,17α,21-Trihydroxypregn-4-ene-3,20-dione
AHFS/Drugs.com Monograph
MedlinePlus a682793
License data
Pregnancy
category
Routes of
administration 		Topical
Drug class Corticosteroid; Glucocorticoid; Mineralocorticoid
ATC code
Legal status
Legal status
Identifiers
  • (8S,9S,10R,11S,13S,14S,17R)-11,17-Dihydroxy-17-(2-hydroxyacetyl)-10,13-dimethyl-2,6,7,8,9,11,12,14,15,16-decahydro-1H-cyclopenta[a]phenanthren-3-one
CAS Number
PubChem CID
DrugBank
ChemSpider
UNII
KEGG
ChEBI
ChEMBL
Chemical and physical data
Formula C21H30O5
Molar mass 362.466 g·mol−1
3D model (JSmol)
  • O=C4\C=C2/[C@]([C@H]1[C@@H](O)C[C@@]3([C@@](O)(C(=O)CO)CC[C@H]3[C@@H]1CC2)C)(C)CC4
  • InChI=1S/C21H30O5/c1-19-7-5-13(23)9-12(19)3-4-14-15-6-8-21(26,17(25)11-22)20(15,2)10-16(24)18(14)19/h9,14-16,18,22,24,26H,3-8,10-11H2,1-2H3/t14-,15-,16-,18+,19-,20-,21-/m0/s1 Yes check.svgY
  • Key:JYGXADMDTFJGBT-VWUMJDOOSA-N Yes check.svgY
 X mark.svgNYes check.svgY  (what is this?)    (verify)

Topical hydrocortisone is a drug under the class of corticosteroids, which is used for the treatment of skin inflammation, itchiness and allergies. [10] Some examples include insect bites, dermatitis and rash. [11] [12] [13]

Contents

Hydrocortisone was discovered by Nobel laureates Edward C. Kendall and Philip S. Hench in the 1930s while they were conducting research on rheumatoid arthritis. [14] [15] [16] Its topical use was first recorded in the 1950s. [17] [18]

The most common adverse effects after the application of topical hydrocortisone are burning and stinging sensations. [10] [11] Side effects after long-term usage include eyesight damage, elevated blood sugar levels and adrenal gland disorders. [12]

Topical hydrocortisone is available in several dosage forms such as solution, lotion, cream, ointment and spray. [19] Some brand names for topical hydrocortisone include Anusol HC, Cortizone 10, and Synacort. [19]

Medical uses

Topical hydrocortisone is indicated for relieving swelling, irritation and redness in a number of skin conditions, including insect bites, heat rash, eczema, psoriasis, contact dermatitis and nappy rash. [12] [19] [20] [21] It could be formulated as a single active ingredient in some medications, e.g. Cortaid®, which is applied for anal itchiness. [13] [22] [23] On some occasions, this drug may be used in combination with other types of drugs to alleviate skin problems. [13] [24] For example, it could be used together with antibiotics such as polymyxin, neomycin and bacitracin to improve dermal conditions. [24]

Adverse effects

Possible adverse effects of topical hydrocortisone Overview of glucocorticoid-associated side effects.png
Possible adverse effects of topical hydrocortisone

Some common side effects include burning and stinging sensations. [10] [11] [21] [25] Colour change of the skin, bump formation on the skin and additional hair growth could also occur. [11] [19] Consult a doctor if these side effects persist or become worse. [11] [19]

Some severe side effects are severe rash, swelling of the skin, and skin infection. [19] Rare but serious allergic reactions, also known as anaphylaxis, could also occur. [12] If you encounter any of these side effects, you should approach a doctor immediately. [19]

Adverse effects after a long-term use of topical hydrocortisone include adrenal gland disorders. [25] This problem can be more severe when you use excess topical hydrocortisone for a prolonged period of time. [25] Other adverse effects include blurry vision, dizziness, fainting, unusual heartbeat, thirsty sensation, frequent urination, and fatigue. [25] Please inform your doctor if you experience any of these symptoms. [25]

The impact of ingestion (eating) of such products has not been reported systematically, but a case report published in 2022 suggests this can lead to hospitalization and be potentially life threatening. [26]

Pharmacology

Pharmacodynamics

Hydrocortisone would bind to glucocorticoid receptors in the human body, which reduces the production of inflammatory transcription factors, phospholipase A2, and NF-kappa B, as well as increases the expression of anti-inflammatory genes. [14] In addition, hydrocortisone has a relatively wide therapeutic window, [14] implying that toxicity is less likely to occur.

Topical hydrocortisone contributes to inflammatory-reducing activity in various ways. [27] Firstly, hydrocortisone can bind to glucocorticoid receptors in the cytoplasm, causing alterations in the conformation of the receptors. [27] [28] This promotes the exchange and binding of proteins at the site of the receptors. [28] The activated receptors then enter the nucleus to upregulate genes for reducing inflammation such as lipocortin. [27] [28] Next, lipocortin inhibits phospholipase A2, an enzyme preventing the synthesis of prostaglandins and lipoxygenases from arachidonic acid. [27] [28] After that, hydrocortisone stabilises the lysosomes in neutrophils, which are a type of white blood cell. [27] Hence, the neutrophils would not degranulate, preventing inflammation. [27] Eventually, mRNA segments are destabilized, affecting gene transcription and interrupting the gene production of cytokines, chemokines, cyclooxygenase-2, etc. [27]

Pharmacokinetics

Topical hydrocortisone has minimal absorption into the body: Only 4-19% of the topical hydrocortisone cream applied would be absorbed into the human bloodstream. [14] After a certain extent of absorption, it undergoes distribution, metabolism and elimination pathways that are similar to systemic hydrocortisone. [29] Regarding the distribution of topical hydrocortisone, it binds to plasma proteins such as globulin and albumin, then the drug is mainly metabolized in the liver, and the metabolite will be excreted through bile or by kidneys. [29]

Chemistry

This is a chemical structure of hydrocortisone with markings of the functional groups that contribute to its glucocorticoid activity. Annotated chemical structure of hydrocortisone.jpg
This is a chemical structure of hydrocortisone with markings of the functional groups that contribute to its glucocorticoid activity.

Structure-activity relationship

Hydrocortisone, or 17-hydroxycorticosterone, is under the class of glucocorticoids, which are steroids synthesized in the adrenal cortex of the kidneys. [30] [31] In order to illustrate its glucocorticoid activity, the A ring of hydrocortisone has a keto group in the 3rd carbon and a double bond between the 4th and 5th carbon. [32] For the C ring of the compound, the 11th carbon has a beta hydroxyl substitution, which is also necessary for the drug to demonstrate glucocorticoid effects. [32]

pKa

The estimated pKa values of hydrocortisone are 12.59 and -2.8 respectively. [14]

Solubility

The log P value of hydrocortisone is 1.61, which was derived from experiments done by pharmacologist Corwin Hansch and his research team. [14] In addition, the predicted water solubility of hydrocortisone is 0.199 mg/mL. [14] These values indicate that hydrocortisone has a low solubility in water and is more soluble in organic solvents.

For other chemical information of topical hydrocortisone, please refer to the 'Topical hydrocortisone' table.

Formulations

Topical hydrocortisone cream available in the United States Tube of hydrocortisone cream.jpg
Topical hydrocortisone cream available in the United States
Topical hydrocortisone cream with neomycin available in Hong Kong Topical hydrocortisone cream with neomycin.jpg
Topical hydrocortisone cream with neomycin available in Hong Kong

Topical hydrocortisone is formulated as liquid, solution, lotion, cream, gel, ointment, foam, and spray. [33] The strength of topical hydrocortisone products ranges from 0.1% to 2.5%, which means there could be 1 mg to 25 mg hydrocortisone in 1g of the products. [12] Some formulations for topical hydrocortisone include hydrocortisone 0.5% cream or ointment, hydrocortisone 1% cream or ointment, and hydrocortisone 2.5% cream or ointment. [34] Regarding the method of applying the medications, please refer to the package insert or consult a pharmacist.

Some less common forms of topical hydrocortisone are also available in the market. For example, hydrocortisone butyrate is a relatively potent topical hydrocortisone cream that can only be purchased when you have a valid prescription. [12] Besides, some forms of topical hydrocortisone are mixed with antimicrobial drugs to treat bacterial or fungal problems of the skin. [12]

History

In the 1930s, hydrocortisone was found by biochemist Edward C. Kendall and rheumatologist Philip S. Hench, who were both Nobel laureates. [14] [15] [16] When they were investigating therapies for rheumatoid arthritis, they discovered that female patients of the disease would experience an alleviation of their condition if they were pregnant at the same time. [15] [16] It was also found that patients suffering from both rheumatoid arthritis and jaundice would have fewer symptoms associated with rheumatoid arthritis. [15] [16] Following this finding, they extracted different hormones from the adrenal cortex of cows in search of a suitable drug. [15] [16] [18] They first identified cortisone to be one of the possible drugs, and further research led them to discover an effective drug for human dermal problems, which was hydrocortisone. [15] [16] [18]

After the discovery of hydrocortisone, the earliest application of hydrocortisone as a topical form in humans was recorded in 1952. [16] [17] [18] Its successful utilization facilitated more research on topical corticosteroids, which helped the development of similar drugs with higher activity. [16] [17] [18]

Related Research Articles

<span class="mw-page-title-main">Corticosteroid</span> Class of steroid hormones

Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex of vertebrates, as well as the synthetic analogues of these hormones. Two main classes of corticosteroids, glucocorticoids and mineralocorticoids, are involved in a wide range of physiological processes, including stress response, immune response, and regulation of inflammation, carbohydrate metabolism, protein catabolism, blood electrolyte levels, and behavior.

<span class="mw-page-title-main">Prednisone</span> Steroid medication

Prednisone is a glucocorticoid medication mostly used to suppress the immune system and decrease inflammation in conditions such as asthma, COPD, and rheumatologic diseases. It is also used to treat high blood calcium due to cancer and adrenal insufficiency along with other steroids. It is taken by mouth.

<span class="mw-page-title-main">Hydrocortisone</span> Glucocorticoid and Mineralocorticoid hormone Cortisol supplied as a medication

Hydrocortisone is the name for the hormone cortisol when supplied as a medication. Uses include conditions such as adrenocortical insufficiency, adrenogenital syndrome, high blood calcium, thyroiditis, rheumatoid arthritis, dermatitis, asthma, and COPD. It is the treatment of choice for adrenocortical insufficiency. It can be given by mouth, topically, or by injection. Stopping treatment after long-term use should be done slowly.

<span class="mw-page-title-main">Glucocorticoid</span> Class of corticosteroids

Glucocorticoids are a class of corticosteroids, which are a class of steroid hormones. Glucocorticoids are corticosteroids that bind to the glucocorticoid receptor that is present in almost every vertebrate animal cell. The name "glucocorticoid" is a portmanteau and is composed from its role in regulation of glucose metabolism, synthesis in the adrenal cortex, and its steroidal structure.

<span class="mw-page-title-main">Prednisolone</span> Chemical compound (steroid medication)

Prednisolone is a corticosteroid, a steroid hormone used to treat certain types of allergies, inflammatory conditions, autoimmune disorders, and cancers. Some of these conditions include adrenocortical insufficiency, high blood calcium, rheumatoid arthritis, dermatitis, eye inflammation, asthma, and multiple sclerosis. It can be taken by mouth, injected into a vein, used topically as a skin cream, or as eye drops. It differs from the similarly named prednisone in having a hydroxyl at the 11th carbon instead of a ketone.

Antipruritics, abirritants, or anti-itch drugs, are medications that inhibit the itching often associated with sunburns, allergic reactions, eczema, psoriasis, chickenpox, fungal infections, insect bites and stings like those from mosquitoes, fleas, and mites, and contact dermatitis and urticaria caused by plants such as poison ivy or stinging nettle. It can also be caused by chronic kidney disease and related conditions.

<span class="mw-page-title-main">Clobetasol propionate</span> Clobetasol Propionate Cream usp 0.05

Clobetasol propionate is a corticosteroid used to treat skin conditions such as eczema, contact dermatitis, seborrheic dermatitis, and psoriasis. It is applied to the skin as a cream, ointment, or shampoo. Use should be short term and only if other weaker corticosteroids are not effective. Use is not recommended in rosacea or perioral dermatitis.

<span class="mw-page-title-main">Triamcinolone</span> Steroid medication

Triamcinolone is a glucocorticoid used to treat certain skin diseases, allergies, and rheumatic disorders among others. It is also used to prevent worsening of asthma and COPD. It can be taken in various ways including by mouth, injection into a muscle, and inhalation.

<span class="mw-page-title-main">Betamethasone</span> Steroid medication

Betamethasone is a steroid medication. It is used for a number of diseases including rheumatic disorders such as rheumatoid arthritis and systemic lupus erythematosus, skin diseases such as dermatitis and psoriasis, allergic conditions such as asthma and angioedema, preterm labor to speed the development of the baby's lungs, Crohn's disease, cancers such as leukemia, and along with fludrocortisone for adrenocortical insufficiency, among others. It can be taken by mouth, injected into a muscle, or applied to the skin, typically in cream, lotion, or liquid forms.

<span class="mw-page-title-main">Methylprednisolone</span> Corticosteroid medication

Methylprednisolone is a synthetic glucocorticoid, primarily prescribed for its anti-inflammatory and immunosuppressive effects. It is either used at low doses for chronic illnesses or used concomitantly at high doses during acute flares. Methylprednisolone and its derivatives can be administered orally or parenterally.

<span class="mw-page-title-main">Desonide</span> Chemical compound

Desonide (INN) is a low-potency topical corticosteroid anti-inflammatory that has been available since the 1970s. It is primarily used to treat atopic dermatitis (eczema), seborrheic dermatitis, contact dermatitis and psoriasis in both adults and children. It has a fairly good safety profile and is available as a cream, ointment, lotion, and as a foam under the tradename Verdeso Foam. Other trade names for creams, lotions, and ointments include Tridesilon, DesOwen, Desonate. It is a group VI corticosteroid under US classification, the second least potent group.

<span class="mw-page-title-main">Betamethasone dipropionate</span> Glucocorticoid steroid (chemical compound)

Betamethasone dipropionate is a glucocorticoid steroid with anti-inflammatory and immunosuppressive abilities. It is applied as a topical cream, ointment, lotion or gel (Diprolene) to treat itching and other skin conditions such as eczema. Minor side effects include dry skin and mild, temporary stinging when applied. Betamethasone dipropionate is a "super high potency" corticosteroid used to treat inflammatory skin conditions such as dermatitis, eczema and psoriasis. It is a synthetic analog of the adrenal corticosteroids. Although its exact mechanism of action is not known, it is effective when applied topically to cortico-responsive inflammatory dermatoses. It is available as a generic medication.

<span class="mw-page-title-main">Mometasone</span> Steroid medication

Mometasone, also known as mometasone y 3 s, is a steroid medication used to treat certain skin conditions, hay fever, and asthma. Specifically it is used to prevent rather than treat asthma attacks. It can be applied to the skin, inhaled, or used in the nose. Mometasone furoate, not mometasone, is used in medical products.

<span class="mw-page-title-main">Loteprednol</span> Pharmaceutical drug

Loteprednol is a topical corticosteroid used to treat inflammations of the eye. It is marketed by Bausch and Lomb as Lotemax and Loterex.

<span class="mw-page-title-main">Amcinonide</span> Chemical compound

Amcinonide is a topical glucocorticoid used to treat itching, redness and swelling associated with several dermatologic conditions such as atopic dermatitis and allergic contact dermatitis. Amcinonide can also be classified as a multi-functional small molecule corticosteroid, which has been approved by the FDA and is currently marketed as an ointment, lotion, or cream. It acts as both a transcription factor for responses to glucocorticoids and modulator for other transcription factors while also regulating phospholipase A2 activity.

In medicine, a finger tip unit (FTU) is defined as the amount of ointment, cream or other semi-solid dosage form expressed from a tube with a 5 mm diameter nozzle, applied from the distal skin-crease to the tip of the index finger of an adult. The "distal skin-crease" is the skin crease over the joint nearest the end of the finger. One FTU is enough to treat an area of skin twice the size of the flat of an adult's hand with the fingers together, i.e. a "handprint". Two FTUs are approximately equivalent to 1 g of topical steroid.

Topical steroids are the topical forms of corticosteroids. Topical steroids are the most commonly prescribed topical medications for the treatment of rash and eczema. Topical steroids have anti-inflammatory properties and are classified based on their skin vasoconstrictive abilities. There are numerous topical steroid products. All the preparations in each class have the same anti-inflammatory properties but essentially differ in base and price.

<span class="mw-page-title-main">Selective glucocorticoid receptor modulator</span> Class of experimental drugs

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<span class="mw-page-title-main">Topical glucocorticoids</span>

Topical glucocorticoids are the topical forms of glucocorticoids. Topical glucocorticoids are used in the treatment of many skin conditions. They provide anti-inflammatory, antimitotic, and immune-system suppressing actions through various mechanisms.

<span class="mw-page-title-main">Antiarthritics</span> Drug class

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References

  1. ↑ "Hydrocortisone topical Uses, Side Effects & Warnings". Drugs.com. Retrieved 11 March 2023.
  2. ↑ "Hydrocortisone topical Pregnancy and Breastfeeding Warnings". drugs.com. Retrieved 26 February 2023.
  3. ↑ "Part A - Interim decisions on matters referred to an expert advisory committee: ACMS#14 (1.1-1.3)". Australian Government. Retrieved 13 April 2023.
  4. ↑ "Rules for the sale, supply and administration of medicines for specific healthcare professionals". National Health Service UK. Retrieved 13 April 2023.
  5. ↑ "Hydrocortisone Notice of enforcement policy" (PDF). U.S. Food and Drug Administration. Retrieved 13 April 2023.
  6. ↑ "Ala-cort- hydrocortisone cream". DailyMed. U.S. National Library of Medicine. Retrieved 13 April 2023.
  7. ↑ "Ala-scalp- hydrocortisone lotion". DailyMed. U.S. National Library of Medicine. Retrieved 13 April 2023.
  8. ↑ "Anusol HC- hydrocortisone acetate suppository". DailyMed. U.S. National Library of Medicine. Retrieved 13 April 2023.
  9. ↑ "Patterns of OTC use in the Netherlands". The Pharma Letter. London. Retrieved 13 April 2023.
  10. 1 2 3 "Pandel (hydrocortisone probutate topical) dosing, indications, interactions, adverse effects, and more". Medscape. WebMD LLC. Retrieved 2023-02-26.
  11. 1 2 3 4 5 "Hydrocortisone Topical: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing - WebMD". WebMD LLC. Retrieved 2023-02-26.
  12. 1 2 3 4 5 6 7 "Hydrocortisone for skin: a steroid medicine for treating eczema, psoriasis and insect bites". nhs.uk. 2019-01-17. Retrieved 2023-02-26.
  13. 1 2 3 "What Is Hydrocortisone Cream Used For? Side Effects". MedicineNet. Retrieved 2023-03-04.
  14. 1 2 3 4 5 6 7 8 "Hydrocortisone". go.drugbank.com. Retrieved 2023-02-26.
  15. 1 2 3 4 5 6 "The Nobel Prize in Physiology or Medicine 1950". NobelPrize.org. Retrieved 2023-03-04.
  16. 1 2 3 4 5 6 7 8 Saenger AK (August 2010). "Discovery of the wonder drug: from cows to cortisone. The effects of the adrenal cortical hormone 17-hydroxy-11-dehydrocorticosterone (Compound E) on the acute phase of rheumatic fever; preliminary report. Mayo Clin Proc 1949;24:277-97". Clinical Chemistry. 56 (8): 1349–1350. doi: 10.1373/clinchem.2010.149120 . PMID   20538878. S2CID   1784993.
  17. 1 2 3 Mukhopadhyay S, Kwatra G (2018). "Evolution and Development of Topical Corticosteroids". In Lahiri K (ed.). A Treatise on Topical Corticosteroids in Dermatology: Use, Misuse and Abuse. Singapore: Springer. pp. 1–9. doi:10.1007/978-981-10-4609-4_1. ISBN   978-981-10-4609-4.
  18. 1 2 3 4 5 Mehta AB, Nadkarni NJ, Patil SP, Godse KV, Gautam M, Agarwal S (2016-07-01). "Topical corticosteroids in dermatology". Indian Journal of Dermatology, Venereology and Leprology. 82 (4): 371–378. doi: 10.4103/0378-6323.178903 . PMID   27279294. S2CID   37156776.
  19. 1 2 3 4 5 6 7 "Hydrocortisone Topical". MedlinePlus Drug Information. U.S. National Library of Medicine. Retrieved 2023-02-26.
  20. ↑ "Hydrocortisone: a steroid used to treat many health conditions". nhs.uk. 2019-03-26. Retrieved 2023-02-26.
  21. 1 2 "Topical Corticosteroids". Drug Office, Department of Health, Hong Kong. Retrieved 2023-03-04.
  22. ↑ "Pruritus Ani (Anal Itch)". Section of Colon and Rectal Surgery. 2015-01-26. Retrieved 2023-03-04.
  23. ↑ "Cortaid (Hydrocortisone Cream and Ointment 1.0%): Uses, Dosage, Side Effects, Interactions, Warning". RxList. Retrieved 2023-03-04.
  24. 1 2 "Neomycin, Polymyxin, Bacitracin, and Hydrocortisone Topical". MedlinePlus Drug Information. U.S. National Library of Medicine. Retrieved 2023-03-04.
  25. 1 2 3 4 5 "Hydrocortisone (Topical Application Route) Side Effects". Mayo Clinic. Retrieved 2023-03-04.
  26. ↑ Saha A, Balakrishnan S, Trivedi N, Agraham GM (21 October 2022). "Hypertension and Severe Hypokalemia Associated With Oral Ingestion of Topical Hydrocortisone Cream". AACE Clinical Case Reports . 9 (1): 2–4. doi:10.1016/j.aace.2022.10.004. PMC   9837079 . PMID   36654996.
  27. 1 2 3 4 5 6 7 Kwatra G, Mukhopadhyay S (2018). "Topical corticosteroids: pharmacology.". In Lahiri K (ed.). A Treatise on Topical Corticosteroids in Dermatology: Use, Misuse and Abuse. Springer. pp. 11–22. doi:10.1007/978-981-10-4609-4_2. ISBN   978-981-10-4609-4.
  28. 1 2 3 4 "glucocorticoid_pharmacology [TUSOM | Pharmwiki]". tmedweb.tulane.edu. Retrieved 2023-04-13.
  29. 1 2 "Hydrocortisone Cream: Package Insert / Prescribing Information". Drugs.com. Retrieved 2023-02-26.
  30. ↑ Chourpiliadis C, Aeddula NR (2023). "Physiology, Glucocorticoids". StatPearls. Treasure Island (FL): StatPearls Publishing. PMID   32809732.
  31. ↑ "Hydrocortisone". PubChem. U.S. National Library of Medicine. Retrieved 2023-04-13.
  32. 1 2 Buchwald P, Bodor N (May 2004). "Soft glucocorticoid design: structural elements and physicochemical parameters determining receptor-binding affinity". Die Pharmazie. 59 (5): 396–404. PMID   15212309.
  33. ↑ "Hydrocortisone (Topical Application Route) Description and Brand Names". Mayo Clinic. Retrieved 2023-02-26.
  34. ↑ "Search results for hydrocortisone". Electronic Medicines Compendium. Datapharm. Retrieved 2023-02-26.
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