General Description
Hydrocortisone acetate is a synthetic glucocorticoid ester of hydrocortisone (cortisol), used primarily for its topical anti-inflammatory and immunosuppressive properties. It is available in a wide range of formulations including creams, ointments, lotions, and suppositories, often at low over-the-counter potencies. The acetate ester improves lipophilicity, enhancing skin penetration and providing a reservoir effect in the stratum corneum.
Mechanism of Action
Following cutaneous absorption, hydrocortisone acetate is hydrolyzed to active hydrocortisone, which binds to cytosolic glucocorticoid receptors. The receptor-ligand complex translocates to the nucleus, modulating transcription of genes involved in inflammation, including suppression of pro-inflammatory cytokines, inhibition of phospholipase A2 via induction of annexin-1, and reduced leukocyte migration. This results in decreased vasodilation, edema, and pruritus at the site of application.
Application
It is indicated for the relief of inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses, including atopic dermatitis, contact dermatitis, eczema, and insect bite reactions. Low-potency formulations (0.5% to 1%) are available without prescription for mild conditions, while higher potencies require a prescription. It should not be applied to infected skin, rosacea, or perioral dermatitis. Prolonged use on large surface areas, particularly under occlusion, can cause systemic absorption and adrenal suppression.