hydrocortisone butyrate: clinical use

Prescribing considerations

• Confirm that the dermatosis is corticosteroid-responsive and not primarily infective.
• Absorption and adverse-effect risk increase on thin or damaged skin, flexures, large areas and beneath occlusion.
• Children and infants are more susceptible to systemic corticosteroid effects.
• Psoriasis requires careful supervision because rebound, generalised pustular psoriasis and systemic toxicity can occur.
• Advise about fabric flammability and possible withdrawal reactions after prolonged use.

Contraindications and cautions

• Hypersensitivity to hydrocortisone butyrate or a formulation excipient.
• Untreated viral, fungal, yeast or parasitic skin infection.
• Tuberculous or syphilitic skin lesions.
• Perioral dermatitis, acne vulgaris or rosacea.
• Bacterial skin infection unless appropriately treated.

Monitoring

• Review worsening or non-responsive disease for infection, hypersensitivity or an alternative diagnosis.
• Check for atrophy, telangiectasia, striae, pigment change and other local corticosteroid effects.
• Consider systemic absorption and adrenal suppression risk when exposure is increased.
• Investigate blurred vision or other visual disturbance.
• Assess spreading erythema, burning or stinging after discontinuation as possible topical corticosteroid withdrawal.

Clinical pharmacology

Hydrocortisone butyrate is a group II, moderately potent topical corticosteroid. It has local anti-inflammatory effects and is metabolised to hydrocortisone and butyric acid.

Formulation and product differences

• Lipocream has a lipid-rich base suitable for dry, scaly lesions and moist or weeping lesions.
• Cream is less fatty and contains cetostearyl alcohol and parahydroxybenzoates, which may cause local reactions in susceptible people.
• Ointment is a soft, fatty formulation generally suited to dry skin.
• Scalp lotion is a clear, alcohol-containing cutaneous solution supplied in a dropper bottle for scalp application.