Hydrocortisone with lidocaine

How it works

Hydrocortisone exerts a local anti-inflammatory and anti-pruritic effect, while lidocaine reversibly blocks neuronal sodium channels to produce local anaesthesia and reduce pain and itching at the application site.

Prescribing in practice

• Limit treatment to short courses, as prolonged or excessive perianal corticosteroid use can cause skin atrophy and the preparation should be avoided where untreated anal/perianal infection (bacterial, fungal or viral) is present.
• Apply sparingly to the affected area, typically after defaecation and at night, and review rather than continue indefinitely if symptoms do not settle.
• Lidocaine sensitivity in the perianal skin is recognised; stop if local irritation, rash or worsening symptoms develop and reconsider the diagnosis.

Monitoring

No routine laboratory monitoring is needed for short topical use; review symptom response and local tolerability and reassess if there is no improvement.

Counselling the patient

• Use only for the short course advised and apply a thin amount to the affected area, washing your hands afterwards.
• Seek review if bleeding, severe pain or symptoms persist, as these may need further assessment.

Evidence & guidelines

Combined corticosteroid–local anaesthetic anorectal preparations are long-established for symptomatic relief; UK guidance and the SPC emphasise short-term use alongside conservative measures.