Hydrocortisone on a pimple: acne is a side effect

No study has tested store-bought hydrocortisone 1 percent cream on a single pimple. The label covers itch, the NHS lists acne among the conditions in which the cream may not be suitable, and MedlinePlus lists acne as one of its side effects. The steroid injection that a dermatologist gives into a deep pimple is a different treatment. This page is part of Skinli's guide to home remedies for acne.

Skinli gives general education and is not a doctor. For the studies below, Skinli read the published summaries (abstracts). No source read for this guide gives a way to use hydrocortisone cream on a pimple, so this page gives none.

What hydrocortisone cream is, and what its label covers

Hydrocortisone is a steroid of the type called a corticosteroid. The NHS says: "Hydrocortisone is a steroid medicine used to treat eczema, insect bites and other skin conditions." It adds that these steroids are "different to anabolic steroids, which some people use illegally to help build bigger muscles." MedlinePlus, from the US National Library of Medicine, says hydrocortisone works "by activating natural substances in the skin to reduce swelling, redness, and itching."

A hydrocortisone 1 percent cream label on DailyMed, the label database of the US National Library of Medicine, reads:

• Active ingredient: "Hydrocortisone, USP 1%"
• Purpose: "Anti-itch"
• Use: "for the temporary relief of itching associated with minor skin irritations, inflammation, and rashes due to:" a list that includes eczema, insect bites, poison ivy, soaps, detergents, cosmetics and psoriasis.
• Any other use: "other uses of this product should be only under the advice and supervision of a doctor"
• Stop and ask a doctor if: "symptoms last for more than 7 days, the condition gets worse, symptoms clear up and occur again in a few days"

A second label, for products sold under the brand name Cortizone-10, lists the same use and the same limit. Acne and pimples appear on neither label, so a pimple falls under the line that sends other uses to a doctor.

What current sources say about hydrocortisone and acne

Source	What it says
NHS, hydrocortisone for skin	People may not be able to use it if they have "acne or rosacea". The same list includes "inflamed skin around your mouth (perioral dermatitis)"
NHS, the same page	Not on the face without talking to a pharmacist or doctor first, because "it can damage the skin in these areas"
MedlinePlus, hydrocortisone on the skin	Its side effect list includes "acne", "tiny red bumps or rash around the mouth" and "small white or red bumps on the skin". The page gives no rates
MedlinePlus, acne	Its list of things that can lead to acne includes "Certain medicines (such as steroids, testosterone, estrogen, and phenytoin)."
AAD page on steroid creams for eczema	"Even a non-prescription topical corticosteroid like hydrocortisone can cause side effects." Topical means put on the skin. The page adds that side effects are rare when the medicine is used as a dermatologist directs
2006 review of steroid cream side effects	"The most frequent adverse effects include atrophy, striae, rosacea, perioral dermatitis, acne, and purpura."

In the review's list, atrophy is thinning of the skin, striae are stretch marks and purpura is bruise-like marks. The review covers steroid creams of every strength and says skin side effects "occur regularly with prolonged treatment". It gives no figures for the 1 percent strength.

No American Academy of Dermatology (AAD) page read for this guide mentions cortisone cream for a pimple. The AAD's list for a deep, painful pimple at home leaves it out.

Two old trials put hydrocortisone inside acne creams

Trial	Who and how long	What was compared	Result
1989, British family practices	107 patients, 12 weeks, four groups	A benzoyl peroxide cream with and without hydrocortisone 1 percent, its base cream alone, and a benzoyl peroxide gel	"The addition of 1% hydrocortisone eliminated the flare reaction to benzoyl peroxide seen in patients in the other two active treatment groups."
1980	44 patients, 3 months	A lotion with hydrocortisone and the same lotion without it	Spot scores fell "from 82 to 11 in the full formulation and from 81 to 8 in the formulation minus hydrocortisone group."

In the 1989 trial the hydrocortisone calmed the flare of redness that benzoyl peroxide caused. The summary does not say that it cleared more acne, and no group used hydrocortisone alone. The first author worked at a clinical trials company. In the 1980 trial, the group with hydrocortisone did better in the first month, "although this did not reach statistical significance." In plain words, the difference could have been chance.

Neither trial tested a cream like the one sold in US stores today on one pimple, and nothing newer was found.

The risk with longer use: a rash that looks like acne

The AAD has a page on perioral dermatitis, a rash around the mouth. It says: "Perioral dermatitis causes a rash, which often looks like acne." On the cause it says: "Many people develop this rash when they apply a corticosteroid medicine to their skin for too long." This includes cream bought without a prescription. The AAD writes: "To clear perioral dermatitis, you must stop applying all corticosteroids, including hydrocortisone cream, to your skin."

Stopping can be hard, and the AAD explains why:

• "When you stop applying a corticosteroid or hydrocortisone cream, the rash can worsen."
• "Using it again will only bring temporary relief. Each time you stop applying it, the rash can flare."
• "It may take a few weeks or a few months to clear completely."

Other sources agree. MedlinePlus says of this rash: "It may occur after using face creams containing steroids for another condition." A 2021 review found "the strongest evidence to support topical corticosteroid misuse as the principal causative factor", in plain words the main cause. A 2014 review adds that steroid cream can make the rash look better, "but there is a risk of rebound when treatment is stopped." Rebound means the rash flares again after the cream is stopped. Skinli's guide on azelaic acid for perioral dermatitis describes the rash and its treatment.

Studies from skin clinics in India describe long use of steroid creams on the face. In one study of 433 people using such creams, 104 used them for acne, and "Acne/exacerbation of acne was the most common adverse effect." Those patients are a different group from US users of hydrocortisone 1 percent. Many used stronger steroids, 258 used a steroid mixed with other drugs, and a related study recorded use that "ranged from 4 months to 20 years."

No source answers the question of short use. No study has measured one or two days of hydrocortisone 1 percent on one pimple, so no source shows that it is harmless or that it is harmful.

The injection a dermatologist gives is a different treatment

	Store-bought cream	Injection by a dermatologist
The drug	Hydrocortisone 1 percent	A corticosteroid. The studies read for this guide used triamcinolone, a different steroid
Where it goes	On the surface of the skin	Into the lump, through a needle
Who uses it	Sold without a prescription, for itch	"Only a doctor should inject a corticosteroid."
What it is for	Itch from rashes and bites	"An injection is fine for treating one especially painful acne nodule or cyst. It cannot be used to treat several acne blemishes."
What sources report	No study on a pimple	"A corticosteroid injection will flatten most acne nodules or cysts within 48 to 72 hours."

A nodule or cyst is a deep, painful lump of acne. The AAD says of the injection: "This speeds healing and reduces the risk of scarring." It also sets limits: "dermatologists reserve this procedure for treating a few severe acne breakouts. Using it more than a few times isn't recommended." Its page on popping adds: "If you receive too much corticosteroid, it can cause unwanted side effects."

The AAD's 2024 acne guideline lists these injections for larger acne spots among its good practice statements. NICE, which writes the acne guideline for England, has deleted its recommendation on them, so it gives no current advice. The injection hurts: in a 2023 study of 64 people, the average pain score without cooling was 5.9 out of 10. The guides on cystic acne and on when to see a dermatologist for severe acne cover what happens at a visit.

Popped pimples and the face

Open skin. The NHS says: "do not use hydrocortisone on cuts or wounds". The 2006 review lists "delayed wound healing, and exacerbation of skin infections" among the less frequent side effects of steroid creams. Exacerbation means getting worse. A popped pimple is a small wound, and what to do after popping a pimple covers the steps the AAD names. The page on Neosporin on a pimple covers antibiotic ointment.

Which cream for the face. No source names one. The NHS answer is to ask a pharmacist or doctor before any use on the face.

What the AAD, the NHS and the FDA rule support

For one deep, painful pimple at home, the AAD gives these steps:

1. Hands off. Squeezing "can make it more noticeable and increase your risk of infection, discoloration, and scarring".
2. Warmth. "apply the warm, damp washcloth to your pimple for 10-15 minutes, three times daily."
3. A tested ingredient. "Choose a product that contains one of these acne-fighting active ingredients: adapalene, azelaic acid, benzoyl peroxide, or salicylic acid." It adds that "a hydrocolloid acne patch can be applied to protect your skin and improve healing."
4. Sun protection. The AAD says some acne ingredients make skin more sensitive to the sun.

For pain, the AAD says: "Relieve pain with ice. Some acne can be painful, especially nodules and cysts. Ice reduces the inflammation." The guide to ice on a pimple explains how.

The NHS acne page says to "try acne treatments you put on your skin such as salicylic acid or benzoyl peroxide". The FDA rule for acne drugs sold without a prescription lists benzoyl peroxide, salicylic acid, sulfur, and sulfur combined with resorcinol. Hydrocortisone is absent from that list. The AAD's acne pages name a maker of prescription acne drugs as their supporter.

When to see a doctor

Stop the cream and see a doctor if you have used hydrocortisone on your face and a rash of small bumps has appeared around the mouth, nose or eyes. MedlinePlus says of perioral dermatitis: "Do not use any over-the-counter steroid creams to treat this condition." It also gives the general limit: "If you obtained hydrocortisone without a prescription (over the counter) and your condition does not improve within 7 days, stop using it and call your doctor."

For the acne itself, the AAD says people with large, painful pimples deep in the skin, or acne that leaves a scar when it clears, need to see a dermatologist for treatment. The NHS says to see a GP, which is a family doctor, if "you have lots of spots, or the spots are deep, painful or causing scars".