Hydrocortison

Hydrocortison, also spelled hydrocortisone in English, refers to the pharmaceutical form of the natural hormone cortisol produced by the adrenal cortex. Synthetic hydrocortisone preparations mimic the action of this hormone and are used for their anti-inflammatory and immunosuppressive effects. Hydrocortison retains some mineralocorticoid activity, which can help with sodium retention and fluid balance, a property relevant to its use in replacement therapy.

Hydrocortison is used in two broad ways. As a replacement therapy for adrenal insufficiency (such as Addison’s disease), it substitutes for cortisol and helps maintain metabolism, stress response, and electrolyte balance. It is also employed for a wide range of inflammatory, allergic, and autoimmune conditions. This includes dermatologic conditions like eczema, dermatitis, and psoriasis; inflammatory joint and soft tissue diseases; and certain airway diseases when delivered by inhalation. Topical hydrocortison preparations are common for skin conditions, while oral tablets and injectable solutions are used for systemic treatment, often with dosing tailored to diagnosis and severity.

Mechanism of action involves binding to intracellular glucocorticoid receptors, which alters gene transcription and reduces the production of inflammatory mediators such as cytokines, prostaglandins, and leukotrienes. This results in decreased edema, immune activation, and tissue damage. The effects depend on the route of administration; topical forms act locally with limited systemic exposure, whereas systemic forms provide broader, longer-lasting effects.

Safety and adverse effects are dose- and duration-dependent. Long-term systemic use can cause Cushingoid features, weight gain, hypertension, glucose intolerance, osteoporosis, and growth suppression in children. Topical use can lead to skin thinning and irritation. Hydrocortison can interact with vaccines and infections may be masked; pregnancy requires medical supervision. Dosing should follow medical guidance and gradual tapering when stopping systemic therapy.

Availability varies by country and includes topical creams, ointments, and gels; oral tablets and injectable solutions are used in clinical care, with some low-strength topical products available over the counter in certain jurisdictions.