Topical corticosteroids, commonly known as cortisone or hydrocortisone creams, are a staple in many medicine cabinets for treating inflammatory skin conditions like eczema and allergic rashes [1.6.1]. They work by reducing swelling, redness, and itching [1.5.2]. However, their potent anti-inflammatory properties mean they must be used correctly. Applying them to the wrong area or for an inappropriate condition can worsen the problem or cause significant side effects [1.2.4].
Areas and Conditions to Avoid
It is critical to know where and when not to use these medicated creams. Misuse, especially over long periods, can lead to skin thinning (atrophy), changes in pigmentation, stretch marks, and even systemic side effects if absorbed into the bloodstream [1.5.3, 1.4.5].
Skin Infections
One of the most critical contraindications for cortisone cream is any type of untreated skin infection. Because corticosteroids suppress the skin's immune response, they can allow infections to thrive and spread [1.4.5, 1.6.3].
- Fungal Infections Applying cortisone cream alone to fungal infections like ringworm, athlete's foot, or jock itch can mask the symptoms while allowing the fungus to multiply, a condition known as tinea incognito [1.4.5, 1.6.1]. The rash may seem to improve initially but will worsen significantly once the cream is stopped or even during use [1.6.1]. Combination creams with an antifungal agent may be prescribed by a doctor, but a steroid-only cream should never be used on a suspected fungal infection [1.6.5].
- Bacterial Infections For bacterial infections like impetigo, applying a topical steroid can worsen the condition [1.5.2]. The cream's immunosuppressive effect hinders the body's ability to fight the bacteria [1.8.4].
- Viral Infections Using cortisone on viral infections such as herpes (cold sores, genital herpes) or shingles can lead to a more severe and widespread outbreak [1.4.1].
Specific Skin Conditions
Certain chronic inflammatory skin conditions can be exacerbated by the use of topical steroids.
- Rosacea While it may temporarily reduce redness, using cortisone cream on rosacea is strongly discouraged [1.10.2]. Long-term use can lead to a rebound effect, making the rosacea much worse upon discontinuation. It can also cause skin thinning and telangiectasias (visible broken blood vessels), a condition sometimes called 'steroid-induced rosacea' [1.10.1, 1.10.4].
- Perioral Dermatitis This rash of small, red bumps around the mouth is often caused or aggravated by the use of topical steroids [1.9.3]. Applying cortisone cream will worsen this condition, and stopping its use is a primary treatment step, though a rebound flare is common [1.9.2, 1.9.4].
- Acne Cortisone cream is not a treatment for acne and can worsen it [1.8.3]. It may cause acne-like breakouts (acneiform eruptions) or clog pores, leading to more comedones (blackheads and whiteheads) [1.4.5, 1.2.5].
Sensitive Body Areas and Broken Skin
The skin is not uniform across the body; some areas are much more sensitive and absorb medication more readily.
- The Face, Eyelids, and Around the Eyes The skin on the face is thinner and absorbs steroids more easily, increasing the risk of side effects like skin thinning, and new or worsened acne and rosacea [1.5.1, 1.5.3]. It should only be used on the face under the specific direction of a doctor [1.5.2]. Application near the eyes is particularly dangerous, as it can increase the risk of glaucoma and cataracts [1.3.2, 1.4.5].
- Groin, Genitals, and Underarms (Intertriginous Areas) These are areas where skin rubs against skin. The thinner skin, increased moisture, and friction make them highly susceptible to side effects like skin atrophy and stretch marks [1.2.4, 1.2.3]. Unless explicitly directed by a physician, avoid applying cortisone in these areas [1.2.1].
- Broken or Damaged Skin You should not apply cortisone cream to open wounds, cuts, burns, or ulcers unless directed by a doctor [1.8.1, 1.8.4]. It can delay the natural healing process and increase the risk of infection [1.8.2].
Comparison Table: Appropriate vs. Inappropriate Use
| Condition / Area | Appropriate Use (with caution & often medical advice) | Inappropriate Use (Avoid) |
|---|---|---|
| Eczema / Atopic Dermatitis | Yes, for managing inflammatory flare-ups [1.5.1]. | On infected eczema without a corresponding anti-infective treatment. |
| Allergic Rashes (e.g., Poison Ivy) | Yes, for reducing itching and inflammation [1.6.1]. | If the skin is broken or blistered, use with caution [1.8.3]. |
| Insect Bites | Yes, for minor reactions to relieve itching and swelling [1.5.1]. | On bites that appear infected (e.g., have pus, red streaks). |
| Face | Only with low-potency creams for short durations under a doctor's guidance [1.5.5]. | For acne, rosacea, or without medical supervision [1.5.2, 1.10.2]. |
| Fungal Infections | No, unless part of a doctor-prescribed combination antifungal/steroid product [1.6.4]. | Using a steroid-only cream will worsen the infection [1.6.1]. |
| Acne & Rosacea | No. | Will exacerbate these conditions [1.2.5, 1.10.3]. |
| Open Wounds/Cuts | No, it can delay healing [1.8.1]. | Application directly into an open wound [1.8.4]. |
| Groin/Underarms | Only if specifically directed by a doctor [1.2.1]. | Routine or long-term application due to high risk of skin thinning [1.2.3, 1.2.4]. |
Conclusion
While cortisone cream is an effective medication for many inflammatory skin issues, its power demands respect and correct usage. The cardinal rule is to avoid applying it to any undiagnosed rash or suspected infection. It should not be used on conditions like acne and rosacea, on broken skin, or on sensitive areas like the face, groin, and underarms without explicit medical direction. Always use the lowest effective strength for the shortest possible duration. If a skin condition does not improve after seven days of over-the-counter use, or if it worsens, stop the cream and consult a healthcare provider [1.2.3].
For more detailed guidance, consider visiting an authoritative source like the NHS page on Hydrocortisone for skin.
