DERMACORT
Clinical safety rating: caution
Comprehensive clinical and safety monograph for DERMACORT (DERMACORT).
Corticosteroid that binds to glucocorticoid receptors, modulating gene expression to reduce inflammation and immune response.
| Metabolism | Hepatic via CYP3A4 |
| Excretion | Primarily hepatic metabolism; metabolites are excreted renally (~75% as glucuronide and sulfate conjugates) and fecally (~25%). Less than 5% of the dose is excreted unchanged in urine. |
| Half-life | Terminal elimination half-life is approximately 2-3 hours for hydrocortisone, the active component. Due to its short half-life, it requires multiple daily doses for sustained effect. |
| Protein binding | Hydrocortisone is 90-95% bound to plasma proteins, primarily corticosteroid-binding globulin (CBG) and albumin. |
| Volume of Distribution | Vd is approximately 0.3-0.5 L/kg for hydrocortisone, indicating distribution primarily into extracellular fluid. |
| Bioavailability | Bioavailability for topical application is variable and minimal systemically (<1% for intact skin, but can increase up to 30-40% with compromised skin barrier or occlusive dressings). |
| Onset of Action | Topical: Onset of anti-inflammatory action is within minutes to hours, with visible improvement often seen within 24-48 hours. No systemic routes are used; topical application only. |
| Duration of Action | Duration of action is approximately 4-8 hours after topical application, depending on formulation and skin condition. Frequent reapplication is needed for chronic conditions. |
| Molecular Weight | 362.46 |
Apply a thin film to affected area twice daily (every 12 hours) for up to 2 weeks.
| Dosage form | CREAM |
| Renal impairment | No dose adjustment required for renal impairment. |
| Liver impairment | No dose adjustment required for hepatic impairment. |
| Pediatric use | Apply a thin film to affected area once daily for no more than 2 weeks; avoid use in children under 2 years. |
| Geriatric use | Use with caution; apply sparingly to limited areas due to increased risk of skin atrophy and systemic absorption. |
| 1st trimester | Topical corticosteroids like Dermacort (hydrocortisone) are generally considered low risk in the first trimester when used in minimal amounts and for short durations. However, systemic absorption is minimal with low-potency formulations, and no significant teratogenic effects have been reported in humans. Avoid prolonged use on large areas. |
| 2nd trimester | Moderate to high potency topical corticosteroids should be used cautiously in the second trimester. Low-potency hydrocortisone is considered safe for short-term use. No increased risk of fetal malformations has been established. |
| 3rd trimester | In the third trimester, topical corticosteroids, especially high-potency, may increase the risk of fetal growth restriction and adrenal suppression if used extensively. Low-potency hydrocortisone is preferred. Use only if clearly needed and avoid high doses over large areas. |
Clinical note
Comprehensive clinical and safety monograph for DERMACORT (DERMACORT).
| Placental transfer | Topical hydrocortisone undergoes minimal placental transfer due to low systemic absorption. Only small amounts reach the fetal circulation. High-potency or prolonged use may increase transfer. Systemic corticosteroids cross the placenta and are metabolized to less active forms. |
■ FDA Black Box Warning
None
| Serious Effects |
Untreated bacterial, fungal, or viral skin infections (e.g., herpes simplex, chickenpox)Hypersensitivity to hydrocortisone or any component of the formulationPerioral dermatitisAcne vulgarisRosacea
| Precautions | Systemic absorption can cause reversible HPA axis suppression, Local irritation, Secondary infection, Skin atrophy with prolonged use |
| Food/Dietary | No significant food interactions reported. Systemic absorption is minimal with topical use; no dietary restrictions required. |
| Clinical Pearls |
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| Breastfeeding | Topical hydrocortisone is minimally absorbed systemically with low-potency formulations. It is considered compatible with breastfeeding. Apply sparingly to small areas and avoid application to the breast or nipple area to prevent infant ingestion. Monitor infant for skin irritation or adrenal effects with prolonged high-dose use. |
| Lactation Rating | L2 (Safer) - Limited data, but minimal risk. |
| Teratogenic Risk | Insufficient human data; animal studies show fetal risk from repeated systemic exposure. Topical use minimizes absorption but avoid prolonged use in first trimester. Corticosteroids may cause intrauterine growth restriction with continuous high-dose therapy. |
| Fetal Monitoring | Monitor maternal blood pressure, blood glucose, and signs of infection with prolonged use. Assess fetal growth via ultrasound if high-potency or extensive area use. |
| Fertility Effects | No known impact on fertility with topical use. Systemic corticosteroids may disrupt menstrual cycles; topical unlikely to affect fertility. |
| Dermacort (hydrocortisone topical) is a low-potency corticosteroid suitable for mild inflammatory dermatoses. Avoid use on infected lesions without concurrent antimicrobial therapy. Limit continuous use to 2 weeks on face or intertriginous areas due to risk of skin atrophy. Apply sparingly and rub in gently; occlusive dressings increase systemic absorption and should be avoided unless directed. |
| Patient Advice | Apply a thin layer only to affected areas; do not use on broken skin or open wounds. · Wash hands after application unless treating hands. · Avoid contact with eyes, mouth, and mucous membranes. · Do not cover treated area with bandages or wraps unless instructed by your doctor. · Do not use for longer than prescribed; prolonged use can cause skin thinning and other side effects. · Inform your doctor if condition worsens or does not improve after 2 weeks. · This medication is for external use only. |