How Does Cortisone Ointment Work? Understanding the Science Behind Skin Relief

October 9, 2025 •

4 min read

According to the National Eczema Association, topical hydrocortisone is a common over-the-counter treatment for eczema, working to calm skin inflammation. But how does cortisone ointment work at a molecular level to produce these effects and alleviate a wide range of skin irritations?

Quick Summary

Cortisone ointment, typically containing hydrocortisone, functions by reducing inflammation, suppressing the immune response, and constricting blood vessels at the site of application. It binds to specific receptors within skin cells to inhibit the chemical pathways that cause redness, swelling, and itching. Proper application is crucial for efficacy and safety.

Key Points

Active Ingredient is Hydrocortisone: What we commonly call cortisone ointment typically contains hydrocortisone, a synthetic version of the body's natural anti-inflammatory hormone, cortisol.
Inhibits Inflammatory Pathways: It works by binding to receptors inside skin cells, which in turn deactivates enzymes and other chemicals responsible for initiating and continuing the inflammatory response.
Reduces Swelling and Redness: Cortisone constricts small blood vessels in the treated area, which reduces localized swelling and the visible redness associated with inflammation.
Potency Varies by Formulation: Ointments generally have a higher potency than creams or lotions of the same strength because the thicker base enhances medication absorption.
Risk of Side Effects with Misuse: Long-term use, especially with stronger prescription formulas or occlusion, increases the risk of side effects like skin thinning, stretch marks, and systemic absorption issues.
Proper Application is Crucial: Use a thin layer only on the affected area, and do not cover it with bandages unless directed by a doctor, to ensure safety and effectiveness.

The Power of Corticosteroids

At its core, cortisone ointment is a topical corticosteroid medication. While "cortisone" is often used generically, the active ingredient in most over-the-counter and many prescription ointments is actually hydrocortisone. Hydrocortisone is a man-made version of cortisol, a steroid hormone naturally produced by the adrenal glands. This natural hormone is released in response to stress and plays a crucial role in regulating inflammation. When applied topically, hydrocortisone mimics this anti-inflammatory action directly on the skin, providing localized relief from redness, swelling, and itching caused by various conditions like dermatitis, eczema, and psoriasis.

The Mechanism of Action: How It Stops Inflammation

For an inflamed area of skin, the body's immune system sends out specialized cells and chemical signals to fight off what it perceives as a threat. This response, while necessary, is what causes the classic symptoms of inflammation. Cortisone ointment works by intervening in this complex process. Its active component, hydrocortisone, travels into the skin cells and binds to specific glucocorticoid receptors located in the cell's cytoplasm.

Once the hydrocortisone binds to these receptors, the receptor-drug complex enters the cell's nucleus, where it can interact directly with the cell's DNA. This interaction serves to upregulate the expression of anti-inflammatory genes, such as those that produce the protein lipocortin, while downregulating pro-inflammatory genes.

The primary anti-inflammatory effects of this process include:

Inhibiting Phospholipase A2: This key enzyme is responsible for synthesizing prostaglandins and leukotrienes from arachidonic acid, two primary chemicals involved in the inflammatory response. By inhibiting this enzyme via lipocortin, hydrocortisone effectively prevents these pro-inflammatory chemicals from being made.
Stabilizing Lysosomes: Hydrocortisone helps stabilize the membranes of lysosomes within neutrophils, a type of white blood cell. This prevents the release of destructive enzymes that contribute to inflammation and tissue damage.
Reducing Immune Cell Activity: It inhibits the accumulation and activation of macrophages and other immune cells in the inflamed area, preventing them from releasing further inflammatory substances.
Constricting Blood Vessels: Cortisone also causes vasoconstriction, the narrowing of the small blood vessels (capillaries) in the area of application. This reduces the localized swelling, redness, and edema.

Choosing the Right Cortisone Ointment

Cortisone ointments come in a variety of potencies, from mild over-the-counter (OTC) options to stronger, prescription-only versions. Choosing the correct one depends on the severity and location of the skin condition, as well as age. For example, lower-potency steroids are often recommended for sensitive areas like the face or for use on children.

Comparison: OTC vs. Prescription Hydrocortisone Ointment


Feature	Over-the-Counter (OTC) Hydrocortisone	Prescription Hydrocortisone
Potency	Low-potency (e.g., 0.5% or 1%).	Ranges from medium to super-high potency.
Application Area	Used for minor, small-area irritations (e.g., insect bites, minor rashes).	Used for more severe or widespread conditions (e.g., severe eczema, psoriasis).
Typical Duration	Short-term use, generally up to 7 days.	Duration varies based on condition and potency; can be longer, but with careful monitoring.
Key Risks	Mild side effects like skin dryness or irritation. Systemic absorption is minimal with proper use.	Greater risk of local side effects (skin thinning, stretch marks) and systemic effects (adrenal suppression) with long-term, high-potency use.
Administration	Applied once or twice daily, following label directions.	Follows specific instructions from a healthcare provider regarding frequency and duration.

Proper Application and Safety Precautions

Proper application of cortisone ointment is essential to maximize its effectiveness and minimize risks. The "fingertip unit" method is often used to guide application, where one unit (the amount covering an adult fingertip) is enough for an area twice the size of a palm. Ointments are generally more potent than creams because they have a thicker base that helps trap moisture and increases absorption.

Crucial safety guidelines include:

Thin Layer: Apply a thin, even layer to the affected area and rub it in gently.
Avoid Occlusion: Do not bandage or wrap the treated area unless specifically instructed by a doctor, as this can significantly increase absorption and the risk of side effects.
Limit Use: Use the ointment for the shortest time necessary to control symptoms. Long-term use of stronger formulations can cause skin thinning (atrophy) or other side effects.
Wash Hands: Always wash your hands after applying the ointment, unless the hands are the area being treated.
Consult a Professional: If symptoms do not improve after a week of OTC use or if they worsen, consult a healthcare provider.

Conclusion

Cortisone ointment offers effective relief from the itching and inflammation of many skin conditions by harnessing the power of corticosteroids, most commonly hydrocortisone. Its mechanism involves complex interactions at the cellular level that suppress the body's inflammatory response and constrict blood vessels, leading to a reduction in redness and swelling. While over-the-counter options are generally safe for short-term, minor irritations, understanding the differences in potency and the proper application techniques is vital. Always consult a healthcare professional for persistent or severe skin conditions to ensure appropriate treatment and minimize the risk of side effects. For more details on hydrocortisone, you can consult sources like this comprehensive resource from Drugs.com on hydrocortisone.

Frequently Asked Questions

Cortisone ointment almost always contains hydrocortisone as its active ingredient. The main difference lies in the formulation and potency. Ointments have a greasy, semi-occlusive base that can increase the absorption and effectiveness of the medication, making them generally more potent than creams of the same strength. Creams are often preferred for their lighter texture.

It is generally not recommended to use cortisone ointment on the face unless specifically advised by a doctor. The skin on the face is much thinner and more sensitive than other parts of the body, making it more susceptible to side effects like skin thinning (atrophy) from topical steroids.

For most over-the-counter products, the duration of use should not exceed 7 days unless a healthcare provider advises otherwise. Prolonged use of topical steroids can increase the risk of side effects and should always be managed under medical supervision.

The most common side effects include mild skin reactions such as burning, itching, dryness, and irritation at the application site. With long-term or high-potency use, more serious side effects like skin thinning, easy bruising, and stretch marks can occur.

Only low-potency hydrocortisone products should be used on children, and often for very short periods. The application area should not be occluded with tight diapers or plastic pants, as this significantly increases absorption and risk. Always consult a pediatrician before use.

When applied topically, cortisone ointment works by locally suppressing the immune cells responsible for the inflammatory response in the skin. This effect is usually confined to the treated area. However, with large, prolonged, or high-potency applications, some systemic absorption can occur, which can potentially suppress the immune system more broadly, though this is less common with topical use.

If your skin condition worsens or shows signs of infection (increased redness, swelling, warmth, pus), stop using the ointment and contact a healthcare professional immediately. It is important to rule out a fungal or bacterial infection, which a steroid ointment could exacerbate.

Applying cortisone ointment after a shower or bath can be effective because the skin is slightly moist, which can enhance absorption. However, wait at least 30 minutes before applying any other products, like a moisturizer, to avoid diluting the steroid.