Hydrocortisone for Acne: How It Works, How to Use It, Side Effects and More

• Hydrocortisone is a corticosteroid that works to reduce inflammation in the body
• This steroid is not an acne treatment but can be used alongside conventional acne treatments to reduce swelling, redness and the discomfort of acne breakouts
• Follow all product instructions and use as a spot treatment only for a short period of time, as extended or overuse can aggravate and worsen symptoms 

Acne first presents as noninflamed whiteheads and blackheads called comedones. These develop when dead skin cells, excess sebum (oil) and other debris cause clogged pores. When Cutibacterium acnes accumulate and multiply, inflamed papules and pustules form; these pimples represent inflammatory acne. While not a typical treatment, hydrocortisone for acne can help alleviate such symptoms of swelling, redness, itching and pain.

What Is Hydrocortisone?

Topical hydrocortisone is a steroid medication that is available in many forms (including lotion, cream, gel and spray) in over-the-counter (OTC) low strengths and stronger prescription strengths. 

This medication is typically used to temporarily relieve inflammatory skin conditions such as eczema and psoriasis as well as insect bites, rashes and poison ivy. These conditions are all associated with swelling, redness and itching.

Oral and injectable hydrocortisone suppresses immune system activity and are prescribed to manage autoimmune diseases such as lupus, chronic obstructive pulmonary disease (COPD) and non-Hodgkin’s lymphoma. 

Topical hydrocortisone is available in OTC strengths from 0.1%–1.0%; more potent forms can only be had with a prescription.  

How Hydrocortisone Works to Treat Acne

Hydrocortisone is not a true acne medication, therefore it cannot treat acne; effective treatments target excess sebum production, clear clogged pores of debris and dead skin cell buildup, and kill C. acnes bacteria.

There are specific established medications, such as antibiotics, benzoyl peroxide and azelaic acid, as well as combinations of these and other therapies to treat and clear acne.

What hydrocortisone can do is effectively treat the unwanted symptoms that accompany acne as it produces an anti-inflammatory response to effectively target swelling, redness, itching and pain. 

Corticosteroids inhibit inflammation by constricting capillaries (very small blood vessels) that result from inflammation. It also calms the body’s natural immune response by preventing and suppressing cell-mediated immune reactions. 

These actions subdue or prevent a tissue response that normally occurs as part of the inflammatory process.

What forms of acne can hydrocortisone treat?

Hydrocortisone can treat the symptoms of inflammatory acne including papules, pustules and cysts. All these types of lesions are characterized by redness, swelling, irritation and pain triggered by bacteria.  

Hydrocortisone has no effect on comedonal acne—blackheads and whiteheads—because these pimples are not inflamed. Comedones consist of excess oil, debris and dead skin cells and P. acnes which is part of the normal flora of the skin; higher levels of bacteria are the cause of inflammation. 

Hydrocortisone for acne scars

Topical application of hydrocortisone is ineffective against scarring; however evidence does support intralesional injections to reduce the volume, thickness and texture of hypertrophic (raised) acne scars. They can also relieve the itching and discomfort that is commonplace with these types of scar tissue.

How to Use Hydrocortisone for Acne

See your dermatologist first before applying a corticosteroid to your face, as it could worsen the condition of your skin.  

Hydrocortisone for acne should only be used short term and as a spot treatment to temporarily reduce inflammation. It can be used alongside established acne treatments to aid in symptom relief.  

For best results, opt for a cream formula, as a gel can block pores and worsen acne symptoms. Select a product with the lowest potency to lower the risk of irritating skin.

Directions: 

1. Wash your hands thoroughly and cleanse your face with a gentle cleanser suited to your skin type and condition
2. Apply a very thin layer of hydrocortisone cream to individual blemishes; avoid the eye, nose and mouth areas
3. Wash your hands thoroughly and continue with your skin care routine

You can use it either morning or night but you should be consistent with your schedule.

How long should you use it? 

Do not use this medication for more than 1 week at a time except if your dermatologist otherwise instructs you to; prolonged use, especially on the face where the skin is particularly thin, can cause a range of adverse effects. As such it is best to err on the side of caution.

Results 

After applying hydrocortisone cream for 1 week, you should expect to see an improvement in your skin with reduced redness, swelling and irritation and an overall decrease in the size of your inflamed blemishes.

Side Effects and Interactions

Hydrocortisone is associated with a range of side effects and can have adverse effects when combined with other medications.

Side effects

Skin atrophy is the most common adverse effect and occurs due to thinning skin with prolonged or excessive use. The loss of connective tissue leads to redness, dilated blood vessels and discolored spots. This can be accompanied by a burning sensation. 

Other side effects include worsening acne, rosacea-like dermatitis or facial perioral dermatitis. 

With cessation of hydrocortisone, all these effects can be reversed but it can take months for the skin to return to a normal state.

More alarmingly, topical hydrocortisone can be absorbed through the skin to produce systemic disruptions including Cushing’s syndrome and hypertension. This is especially true for inflammatory skin conditions, as these conditions indicate a disrupted skin barrier and this causes better absorption of all topical products.

Interactions

Hydrocortisone can interact with hundreds of medications, making this another reason you should obtain medical advice before using. 

Alternatives

There are many established, safe and effective alternatives to hydrocortisone that will not only calm inflammatory symptoms, but will work to heal the acne itself.

Depending on the severity of your acne and your individual response, these alternatives can be used alone or in combination with other medications.

Antibiotics

Topical antibiotics, in the form of creams and ointments, are effective at treating inflammatory acne by targeting and killing acne-causing bacteria which in turn reduces inflammation. Antibiotics are usually reserved for moderate-to-severe acne or treatment-resistant cases and used for a specific length of time. 

In addition, combining oral antibiotics with a topical retinoid or benzoyl peroxide can produce better results. 

Benzoyl peroxide

Clinical research demonstrates that benzoyl peroxide is one of the safest and most effective treatments for mild-to-moderate acne and is usually used as first-line therapy. This compound can kill acne-causing bacteria, clear oily skin of excess sebum and slough off dead skin cells to both heal active acne and prevent future outbreaks. 

Benzoyl peroxide is one of the most frequently used acne treatments and can be used alone or in combination with other medications such as topical retinol. It also pairs well with niacinamide, a derivative of vitamin B3, as it provides anti-inflammatory effects and acts as a moisturizer to counteract the drying effects of benzoyl peroxide.

You can find this active ingredient at the drugstore in a wide range of skin care products from cleaners, toners, lotions, gels, creams and masks. 

Retinol

Retinol is a mainstay treatment for inflammatory acne as it clears pores of buildup, speeds up skin cell turnover, regulates sebum production and kills bacteria. All these actions have been demonstrated to significantly reduce inflammatory lesions and related unwanted symptoms.

You can find retinol at your drugstore in serums, creams, gels and oils, typically in strengths of 0.5%–1.0%. As retinol can cause peeling, redness and irritation, it is advised to begin with a low concentration and to use once per week until your skin is accustomed to it.

You can combine benzoyl peroxide with retinol but use the former in the morning and the latter at night; using both at the same time can cancel their benefits and cause significant irritation and dryness. 

Takeaway

Hydrocortisone is not formulated to treat any form of acne but can be used in the short term as a temporary solution to reduce inflammatory acne symptoms by calming redness, itchiness, swelling and pain. 

Hydrocortisone can be used once a day for 1 week as a spot treatment using a low-strength cream. Avoid prolonged use as corticosteroids can cause a range of serious skin and systemic issues.

The best way to treat acne is by using one or more acne medications, as these are safe for skin and tried-and-true solutions. They are proven to treat and heal acne by killing acne-causing bacteria, reducing levels of sebum and clearing skin of dead skin cells and debris.