Hydrocortisone butyrate

How it works

It binds glucocorticoid receptors in skin cells to produce anti-inflammatory, immunosuppressive and vasoconstrictive effects; despite the hydrocortisone name, the butyrate ester confers potent activity.

Prescribing in practice

• Note that, unlike plain hydrocortisone, hydrocortisone butyrate is a potent steroid, so apply the lowest effective amount for the shortest time and take particular care on the face and flexures to limit atrophy and systemic absorption.
• Reserve for inflammatory dermatoses requiring a potent agent and step down as control is achieved.
• Do not apply to untreated bacterial, fungal or viral skin infection.

Monitoring

No routine laboratory monitoring is required; review for treatment response and local corticosteroid adverse effects such as skin thinning.

Counselling the patient

• This is a strong steroid despite its name; apply thinly to affected areas only and not as a general moisturiser.
• Avoid the face and skin folds unless specifically directed and do not use on infected skin.
• Continue regular emollients alongside treatment.

Evidence & guidelines

Topical corticosteroids are central to NICE eczema management, with potent agents such as hydrocortisone butyrate selected by disease severity and site.