Hydrocortisone cream for eczema: How it works, how to use it, and alternatives

In this article:

• Does hydrocortisone cream help with eczema?
• How to use hydrocortisone cream for eczema
• When to expect relief
• Side effects
• Alternatives
• Cost of hydrocortisone cream
• FAQs

In this article

• Does hydrocortisone cream help with eczema?
• How to use hydrocortisone cream for eczema
• When to expect relief
• Side effects
• Alternatives
• Cost of hydrocortisone cream
• FAQs

Hydrocortisone cream is one of the most commonly used over-the-counter (OTC) treatments for managing the itching and inflammation associated with atopic dermatitis, also called eczema. OTC topical hydrocortisone is widely available in 0.5% and 1% formulations, while prescription versions come in a stronger concentration of 2.5%. While hydrocortisone can significantly relieve eczema symptoms, it does not cure the condition. A daily moisturizing regimen is also key to managing flare-ups.

Does hydrocortisone cream help with eczema? 

Yes, hydrocortisone cream can help relieve eczema symptoms, including itching, redness, and inflammation. However, hydrocortisone cream manages eczema flares but does not cure eczema. Topical corticosteroids such as hydrocortisone work by reducing inflammation, slowing cell division, and suppressing immune responses. These effects reduce the overactive immune response in the skin that drives eczema flares. 

In the U.S., hydrocortisone 1% cream, lotion, and ointment are available OTC for mild eczema. Prescription-strength formulations at 2.5% are used for moderate to severe eczema under healthcare provider guidance. 

How do you use hydrocortisone cream for eczema? 

Knowing how to apply hydrocortisone cream correctly can improve results and reduce the risk of side effects. 

Application guidelines

According to the drug label, hydrocortisone cream can be used in adults and children 2 years of age and older. Apply a thin layer to the affected area no more than three to four times daily. Gently rub the cream in until absorbed. Wash your hands before and after applying the medication.  

Where to and not to use it

Hydrocortisone cream is appropriate for eczema-affected skin on the body, but there are important areas to avoid. Per the drug label, avoid contact with the eyes, including indirect contact from skin that has had the cream applied to it. Do not use it to treat diaper rash without a healthcare provider’s guidance. Avoid applying hydrocortisone cream to broken skin. 

“Another common mistake is to apply it to the delicate skin of the genitals or around the eyes for a long time, as it can cause skin thinning that appears red, similar to stretch marks,” warns Tanya Kormeili, MD, board-certified dermatologist in Santa Monica. The face, skin folds, and groin also have thinner skin, so use caution when applying hydrocortisone cream to these areas, as it can thin the skin further. 

Higher-strength hydrocortisone cream may be needed for eczema affecting areas with thicker skin, such as the palms or soles. A healthcare provider can guide the right approach for individual situations. 

Hydrocortisone application tips for best results

There are currently no universal medical guidelines on how to apply hydrocortisone for eczema. For best results, consider the following tips: 

• The American Academy of Dermatology (AAD) recommends applying hydrocortisone twice daily if moisturizers aren’t working well enough alone to control symptoms, though once daily may be sufficient. 
• Some experts recommend applying hydrocortisone cream before moisturizer when using both products. “The most effective way to use hydrocortisone cream for the treatment of eczema is to apply a thin layer to the affected area and let it sit for several minutes. After that, apply a fragrance-free moisturizer to the area,” says Allen Masry, MD, a healthcare provider based out of Blackwood, New Jersey.
• One fingertip unit (FTU) is approximately equal to 0.5 g of hydrocortisone cream, and one FTU covers an area roughly the size of one hand, front and back. Depending on the area affected, a healthcare provider or pharmacist may recommend a certain number of FTUs for a specific area. For example, one arm can be covered by 3 FTUs. 
• Follow a dermatologist’s or healthcare provider’s instructions carefully. Though the drug label for 1% hydrocortisone suggests applying the cream up to four times daily, prescription-strength hydrocortisone may only need to be applied once daily to avoid unwanted side effects. 
• Tools such as the EczemaWise app by the National Eczema Association (NEA) can help track symptoms, set treatment reminders, and monitor eczema management. 

Can you use hydrocortisone cream every day?

Over-the-counter hydrocortisone cream is not recommended for long-term daily use without a healthcare provider’s guidance. According to the drug label, if symptoms do not improve after seven days, or if they clear up and recur within a few days, stop use and consult a healthcare professional before using any other hydrocortisone product. 

Long-term daily use of hydrocortisone cream can increase the risk of side effects such as skin thinning, stretch marks, and acne. “[Hydrocortisone cream] can be applied directly to the affected skin up to two weeks,” Dr. Kormeili shares. But long-term use requires caution. Dr. Kormeili warns that side effects like skin atrophy can be hard to reverse fully, even after stopping topical hydrocortisone. If eczema is chronic or frequently recurring, work with a healthcare provider on a safe long-term management plan. 

How quickly does hydrocortisone cream work for eczema? 

“Most individuals notice improvements to their eczema symptoms, such as itching and redness, within a couple of days,” says Dr. Masry. “However, individuals who experience more severe cases of eczema typically require anywhere from one to two weeks before they see improvement in their symptoms.”

Individual responses vary based on the severity of the flare-up and skin type. If symptoms worsen, spread to new areas, become painful, or the affected area begins to ooze without improvement, seek medical attention. As Dr. Masry notes, “In these cases, there could be more going on than just eczema, such as infection, allergies, or another skin condition that needs to be assessed.”

What are the side effects of hydrocortisone cream?

The most common side effects of hydrocortisone cream include burning, itching, irritation, and dry skin at the application site. Folliculitis, an inflammation of the hair follicles, can also occur at the site of application. These side effects are generally mild and tend to occur with normal, short-term use.

More serious side effects are associated with prolonged use or application over large surface areas. Topical hydrocortisone cream applied over large areas or long-term, can be absorbed and produce systemic (whole-body) effects, such as interfering with normal cortisol signaling. Allergic reactions are also possible. If one occurs, stop using the cream immediately and seek medical attention.

Long-term use can lead to skin thinning (atrophy), stretch marks (striae), and skin fragility at the application site. Areas with already thin skin, such as the face and skin folds, absorb hydrocortisone more readily, increasing the risk of side effects.

If you experience any of these side effects and your eczema does not improve after seven days of consistent use, consult a healthcare provider for further evaluation. 

What are the alternatives to hydrocortisone cream for eczema?

For people who need more than OTC hydrocortisone cream, alternatives fall into three main categories: over-the-counter options, prescription treatments, and nonmedicinal management strategies. 

Over-the-counter alternatives

Moisturizers are foundational to eczema management, according to the AAD. They help relieve dry, cracked skin, reduce inflammation, and can decrease the severity of eczema flare-ups and the time between them. The National Eczema Association recommends moisturizers containing ceramides, oat or shea butter, aloe, glycerin, petrolatum, vitamin E, or niacinamide to help restore the skin barrier. OTC itch relief products containing pramoxine or colloidal oatmeal can also provide temporary relief between flares. 

Prescription alternatives

For moderate to severe eczema, a healthcare provider may recommend stronger topical corticosteroids or non-steroidal options. Hydrocortisone at 1% and 2.5% are considered Class VII, the least potent topical corticosteroids. Other corticosteroids, such as betamethasone dipropionate 0.05% (Class IV and V, medium-potency) or clobetasol 0.05% (Class I, superpotent), may be considered.

Topical calcineurin inhibitors, including Prograf (tacrolimus) and Elidel (pimecrolimus), reduce inflammation and itchiness and are particularly useful for sensitive areas or when corticosteroids are not suitable. Eucrisa (crisaborole), a phosphodiesterase-4 (PDE-4) inhibitor, is another non-steroidal prescription topical option that can reduce inflammation and relieve itching.

Injectable medications such as Dupixent (dupilumab) are approved by the U.S. Food and Drug Administration (FDA) to treat moderate to severe eczema in adults and children over 6 months when topical prescription therapies do not work.

Nonmedication alternatives

Lifestyle changes are essential to managing eczema symptoms and preventing flare-ups. Identify and avoid personal triggers such as wearing certain fabrics, using certain soaps or skincare products, and being exposed to environmental allergens such as fragrances. The AAD recommends wearing loose-fitting, 100% cotton clothing, using fragrance- and dye-free laundry detergent, and removing or covering clothing tags that can irritate the skin. Protect your skin from extreme temperatures; cold can dry your skin, while heat can cause sweating and further irritation. 

Maintain a consistent, gentle skincare routine with emollients and moisturizers to protect the skin barrier, which is a baseline strategy for many people with eczema to help prevent flare-ups. 

Wet wrap therapy involves applying a damp layer of gauze, bandages, or clothing over topical treatments such as medicated creams or moisturizers, followed by a dry layer over the wet layer. “If you occlude the hydrocortisone with any type of plastic, it actually penetrates the skin deeper and can become stronger than the 1% you are using,” says Dr. Kormeili. This technique is used during severe flare-ups and usually requires healthcare provider guidance.

The right treatment plan depends on eczema severity and individual response to treatment. Talk to a dermatologist or healthcare provider to build a long-term symptom management strategy that works for you.

How much does hydrocortisone cream cost?

Generic OTC hydrocortisone (1%) is generally more affordable than prescription-strength formulations and is widely available at pharmacies and retail stores. Prescription-strength hydrocortisone and higher-potency steroids vary in cost depending on whether they are generic or branded, the dose and size of the product, and whether you are using insurance or a discount card. The average retail price for prescription-strength hydrocortisone 2.5% is $28 for 1, 30 gm tube, though SingleCare members can pay as little as $5 for the same quantity at participating pharmacies. 

Frequently asked questions

How long should I use hydrocortisone cream?

OTC hydrocortisone cream is intended for short-term use. If symptoms worsen or do not improve after seven days, stop use and speak to a healthcare professional. 

Why isn’t hydrocortisone working for my eczema?

There are many possible reasons hydrocortisone may not be controlling your eczema symptoms. Your hydrocortisone cream could be too low a potency for moderate to severe symptoms, it may be applied incorrectly, or your symptoms may not be eczema. Sometimes skin infections can look like eczema and will not respond to hydrocortisone treatment. Consult a healthcare provider for a full evaluation if you are not sure whether hydrocortisone is the right treatment for you. 

What’s stronger than hydrocortisone for eczema?

Prescription-strength 2.5% hydrocortisone is stronger than 1% OTC hydrocortisone cream. There are also other topical corticosteroids stronger than hydrocortisone, such as betamethasone and clobetasol; non-steroidal options such as tacrolimus and pimecrolimus; and injectable medications such as Dupixent (dupilumab) that a healthcare provider may consider.