Introduction
Westcort (hydrocortisone valerate) is a medium-potency topical corticosteroid used to treat various inflammatory skin conditions. As a synthetic glucocorticoid, it provides anti-inflammatory, antipruritic, and vasoconstrictive effects while being formulated for cutaneous application to minimize systemic absorption.
Mechanism of Action
Hydrocortisone valerate exerts its therapeutic effects through binding to intracellular glucocorticoid receptors. This complex then translocates to the nucleus where it modulates gene transcription, resulting in:
- Inhibition of inflammatory cytokine production
- Decreased vasodilation and capillary permeability
- Suppression of migration of polymorphonuclear leukocytes
- Reduction in fibroblast proliferation and collagen synthesis
The valerate ester enhances lipid solubility, improving percutaneous penetration and prolonging duration of action compared to plain hydrocortisone.
Indications
FDA-approved indications include:
- Relief of inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses
- Atopic dermatitis
- Contact dermatitis
- Eczema
- Psoriasis (less severe cases)
- Seborrheic dermatitis
Dosage and Administration
Standard dosing: Apply a thin film to affected areas 2-4 times daily Formulations: 0.2% cream, ointment, and lotion Application: Gently rub into affected areas until medication disappears Duration: Use should be limited to 2 weeks for most indications unless directed by physician Occlusive dressing: May be used for resistant dermatoses under medical supervision Special populations:- Pediatric patients: Use should be limited to the minimal effective dose and duration
- Geriatric patients: Increased risk of cutaneous atrophy; monitor closely
- Hepatic impairment: No specific dosage adjustment recommended
- Renal impairment: No specific dosage adjustment recommended
Pharmacokinetics
Absorption: Percutaneous absorption depends on vehicle, integrity of epidermal barrier, and use of occlusive dressings. Absorption ranges from 1-5% through intact skin. Distribution: Primarily local tissue distribution; systemically absorbed drug is bound to transcortin and albumin Metabolism: Primarily hepatic via CYP3A4 to inactive metabolites Elimination: Renal excretion of metabolites (50-70%) with minor fecal elimination Half-life: Plasma half-life approximately 1.5-2 hours for systemically absorbed drugContraindications
- Hypersensitivity to hydrocortisone valerate or any component of the formulation
- Viral skin infections (herpes simplex, varicella)
- Fungal infections without appropriate antifungal therapy
- Tuberculosis of the skin
- Perioral dermatitis
- Rosacea
- Acne vulgaris
Warnings and Precautions
Systemic effects: May occur with extensive application, prolonged use, or occlusive dressing HPA axis suppression: Possible with large surface area coverage or prolonged use Cutaneous atrophy: Striae, telangiectasia, and skin thinning may occur Infections: May mask signs of infection; secondary infection may develop Pediatric patients: Increased risk of systemic absorption due to higher surface area to body mass ratio Pregnancy: Category C - use only if potential benefit justifies potential risk Lactation: Systemically absorbed corticosteroids may appear in breast milkDrug Interactions
No clinically significant pharmacokinetic interactions documented Theoretical considerations:- Increased systemic absorption may potentiate effects of systemically administered corticosteroids
- May alter response to skin tests
- Concurrent use with other topical products may increase irritation or absorption
Adverse Effects
Common (≥1%):- Burning sensation
- Pruritus
- Irritation
- Dryness
- Folliculitis
- Hypertrichosis
- Hypothalamic-pituitary-adrenal (HPA) axis suppression
- Cushing's syndrome
- Hyperglycemia
- Glaucoma (with periocular use)
- Secondary skin infections
- Contact dermatitis
- Skin atrophy
- Striae
Monitoring Parameters
- Clinical response to therapy
- Signs of skin atrophy or striae
- Evidence of secondary infection
- Signs of systemic absorption with extensive use (weight gain, edema, hypertension)
- Pediatric growth parameters if used long-term
- Periodic evaluation of need for continued therapy
Patient Education
- Use only as directed by healthcare provider
- Apply thin film to affected areas only
- Avoid contact with eyes
- Do not use on face, groin, or axillae unless directed
- Report any signs of skin irritation, infection, or lack of improvement
- Do not bandage or wrap treated areas unless instructed
- Inform all healthcare providers about topical corticosteroid use
- Do not use longer than prescribed period
- Store at room temperature away from moisture
References
1. FDA prescribing information: Westcort (hydrocortisone valerate) cream 2. Wolverton SE. Comprehensive Dermatologic Drug Therapy. 4th ed. Elsevier; 2021 3. Bolognia JL, Schaffer JV, Cerroni L. Dermatology. 4th ed. Elsevier; 2018 4. Hengge UR, Ruzicka T, Schwartz RA, et al. Adverse effects of topical glucocorticosteroids. J Am Acad Dermatol. 2006;54(1):1-15 5. Barnes PJ. Anti-inflammatory actions of glucocorticoids: molecular mechanisms. Clin Sci (Lond). 1998;94(6):557-572 6. Lacour JP, Ulrich M, Saurat JH. [Topical corticosteroids]. Ann Dermatol Venereol. 2002;129(6-7):855-862