Hydrocortisone

We've all been there. Your skin is behaving beautifully, clear and calm, with no blemishes in sight. You applaud yourself for finally nailing the perfect skincare routine, post IG stories with no filter, and rock the no-makeup look like no one's business. And then, wham. Out of nowhere, when you least expect it, a huge, honking pimple pops up out of nowhere. You know, the kind that's so big it should have its own zip code and is legit painful. It's also probably appeared at the least opportune time, like before a big presentation at work, or a first date that you were actually excited about. 

What is Hydrocortisone?

"Hydrocortisone is a corticosteroid, a medicine that reduces inflammation," explains Zeichner. It's a common anti-inflammatory treatment for skin conditions such as eczema or psoriasis, adds Carqueville, and is available both over-the-counter and as a prescription. (A one-percent concentration is the maximum strength available without a prescription.)2 And to the over-the-counter point, it's often a go-to treatment for itchy, irritated, skin problems—think bug bites, rashes, poison ivy, and the like.

On the acne front, you may have heard of dermatologists using cortisone injections to quickly calm large, angry pimples. While both cortisone and hydrocortisone belong to the same family of corticosteroids, cortisone has to be converted to hydrocortisone in the liver,3 and won't work topically (hence the injection part). Still, over-the-counter hydrocortisone may offer a similar benefit to the injectable cortisone, says Zeichner. To that point...

It's important to first point out that, because hydrocortisone works by combating inflammation, "it's not meant for blackheads or whiteheads, but rather for red, angry, underground pimples," says Carqueville. It's also not something you should be using across you entire face; instead, it's best for super targeted spots and used for only short amounts of time (more on both points in a moment). However, it definitely is effective at combating inflammation. It works particularly well when paired with not only benzoyl peroxide, but also salicylic acid, sulfur, and retinoids: "These ingredients work together to reduce the causes of an inflamed pimple—the oil at the skin surface, the clogging of the pore, and the acne-causing bacteria P. acnes," explains Carqueville. 

As mentioned, it's going to work best when paired with other ingredients. Try Zeichner's homemade spot treatment and combine a one-percent OTC hydrocortisone cream plus a product containing two percent salicylic acid plus a product containing two-and-a-half percent benzoyl peroxide (use equal parts of each). Dab this concoction directly onto the pimple. Carqueville suggests first washing your face with a sulfur-based cleanser, then layering the hydrocortisone under a five-percent benzoyl peroxide product in the morning. 

So why should hydrocortisone use be limited? "Overuse of topical steroids can lead to thinning and discoloration of the skin," cautions Carqueville. She advises using hydrocortisone on a blemish no more than twice daily, for two days max. Zeichner also warns about the overuse of topical steroids (though says you can use hydrocortisone on a blemish for up to two weeks). In an ironic twist, another possible side effect can be even more pimples: "Steroid acne is a well-described phenomenon where continuous use of topical steroids causes acne," says Zeichner. Overuse can also lead to steroid-induced dermatitis, perioral dermatitis specifically, which manifests as a red, bumpy rash around your nose and mouth, adds Carqueville. No, thank you.