Hydrocortisone
Considered a low potency topical corticosteroid, hydrocortisone is useful for the adjunctive treatment of localized pruritic and/or inflammatory conditions. * **Safety Profile**: Because risks associated with hydrocortisone are significantly less compared to higher potency corticosteroids, it is a reasonable first choice, particularly when treating large areas or smaller patients. * **Synergistic Ingredients**: Some products contain the astringent Burow's solution, which provides additional antipruritic effects. * **Clinical Pearl**: Ideal for focal (e.g., pedal) or multifocal lesions for relatively short durations (less than 2 months).
Mechanism: Corticosteroids are non-specific anti-inflammatory agents. They act by inducing **phospholipase A2 inhibitory proteins (lipocortins)** in cells → reducing the formation, activity, and release of endogenous inflammatory mediators (e.g., **histamine, prostaglandins, kinins**). They also reduce DNA synthesis via an anti-mitotic effect on epidermal cells and inhibit the migration of leukocytes and macrophages to the area, reducing erythema, pruritus, and edema.
Dosing by species
- Focal or multifocal pruritic/inflammatory lesions · Initially used sparingly 1-4 times per day and then frequency is tapered when control is achieved. Shampoos: once a day to once a week (leave on 10 mins). · topical · q6-24h · < 2 months
- Focal or multifocal pruritic/inflammatory lesions · Initially used sparingly 1-4 times per day and then frequency is tapered when control is achieved. Shampoos: once a day to once a week (leave on 10 mins). · topical · q6-24h · < 2 months
Doses are a clinical reference for licensed veterinary professionals. Always confirm against the current label and the individual patient.
Routes of administration
Contraindications
- Tuberculosis of the skin
- Pregnancy (relative contraindication)
- Pregnant animals
- Renal disease (systemic use generally contraindicated)
- Diabetes mellitus (systemic use generally contraindicated)
Adverse effects
- Skin atrophy (with long-term use)
- Skin fragility
- Superficial follicular cysts (milia)
- Comedones
- HPA axis suppression (rare, but possible with long-term use)
- Weight loss (catabolic effect)
- Cutaneous atrophy
- Iatrogenic hyperadrenocorticism (PU/PD, elevated liver enzymes)
- Vomiting
- Diarrhoea
- Gastrointestinal ulceration
- Increased urine glucose levels
- Decreased serum T3 and T4 values
- Hypothalamic-pituitary axis suppression (with prolonged use)
- Adrenal atrophy
- Impaired wound healing
Drug interactions
- NSAIDs · Increased risk of gastrointestinal ulceration · major
- Insulin · Glucocorticoids antagonize the effect of insulin · major
- Phenobarbital · May accelerate the metabolism of corticosteroids · moderate
- Itraconazole · May decrease the metabolism of corticosteroids · moderate
- Acetazolamide · Increased risk of hypokalaemia · moderate
- Amphotericin B · Increased risk of hypokalaemia · major
- Furosemide · Increased risk of hypokalaemia · moderate
- Thiazide diuretics · Increased risk of hypokalaemia · moderate
Monitoring
- Resolution of clinical signs (pruritus, erythema)
- Signs of skin atrophy or secondary infection
- Serum electrolytes (especially Sodium and Potassium)
- Liver enzymes
- Blood and urine glucose
- Clinical signs of GI ulceration
- Thyroid panel (T3, T4) if indicated
Overdose
Overdose via topical application is unlikely, but chronic overuse can lead to iatrogenic hyperadrenocorticism (Cushing's syndrome) and HPA axis suppression.
VetSheet drug reference is intended for licensed veterinary professionals as a clinical decision-support aid, not a substitute for professional judgement or the manufacturer’s current label.