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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. In times like these, there's an unsuspecting ingredient that you can use as a fast and effective spot treatment—and it's one you may already have squirreled away somewhere in your bathroom. We're talking about hydrocortisone cream. Ahead, New York City dermatologist Joshua Zeichner, MD, and Chicago dermatologist Jordan Carqueville, MD, explain exactly how hydrocortisone works, and exactly how you should use it.
Type of ingredient: Corticosteroid (anti-inflammatory)
Main benefits: As a spot treatment, reduces redness and inflammation from breakouts.
Who should use it: Anyone (who isn't allergic to the ingredient) looking to target a specific inflamed breakout, rather than an area of the face.
How often can you use it: Apply no more than twice daily for up to two weeks.
Works well with: Benzoyl peroxide, salicylic acid, sulfur, and retinoids.
Don’t use with: Other hydrocortisone products or on cortisone injection sites.
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.) 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, 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...
Hydrocortisone for Acne
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. However, it's worth noting that when choosing an OTC hydrocortisone for blemish-busting purposes, it's important to seek out a cream formula, rather than an ointment. The occlusive texture of an ointment can be inherently pore-clogging, says Carqueville.
How to Apply Hydrocortisone
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. Repeat this in the evening, swapping the benzoyl peroxide product for one with either a two-percent salicylic acid product or an over-the-counter retinoid. In either scenario, this is meant to be a short-term, quick-fix, and not a regular part of your skincare routine.
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.
The Best Products with Hydrocortisone
Along with hydrocortisone, this also boasts a triple oat complex; colloidal oats are a choice skin soother to help further reduce inflammation, says Zeichner. The formula also boasts soothing aloe and vitamin E, too.
Aloe, linseed oil, honey, and hyaluronic acid make this nice and moisturizing, helping to combat the dryness that can often occur when you're trying to knock out a pimple. (And that can come from the other blemish-busting ingredients you may be pairing it with.) It's a bit pricey yes, but one tube lasts forever, and since hydrocortisone can be used for so many things, you are getting a good bang for your buck.
Dermatologists love this brand for its use of ceramides, which play an essential role in keeping your skin barrier strong and healthy. They're found in this OTC hydrocortisone as well, making this an especially great pick if you're looking for a product that you can use not only as an emergency spot treatment, but also to tamp down eczema flares.
A drugstore staple, this option is readily-available and rings in at a very wallet-friendly price tag. It's non-greasy and penetrates quickly, and also contains skin-calming aloe.
Vanicream is another brand beloved by derms, given that their products are geared towards sensitive skin. Case in point: This formula is fragrance-, paraben-, and dye-free, all common irritants. Plus, it's also non-comedogenic, so you definitely don't have to worry about it clogging pores.
Meckfessel MH, Brandt S. The structure, function, and importance of ceramides in skin and their use as therapeutic agents in skin-care products. J Am Acad Dermatol. 2014;71(1):177-184. doi:10.1016/j.jaad.2014.01.891