Fucidin H
Is It Right for You?
A complete guide to Fucidin H — what it treats, how it works, dosages, side effects, and when a clinician may prescribe it following an online consultation.
What Is Fucidin H?
Fucidin H is a topical combination preparation containing two active ingredients: fusidic acid 2% (an antibiotic) and hydrocortisone acetate 1% (a mild corticosteroid). It is manufactured by LEO Pharma and is available only on prescription. It is supplied as a cream (the most commonly used formulation) and as an ointment (for drier, more lichenified lesions or where a more occlusive formulation is required).
The rationale for combining an antibiotic with a corticosteroid is based on the common clinical scenario of eczema or dermatitis that has become secondarily infected with Staphylococcus aureus — the most frequent skin pathogen in this context. The fusidic acid component targets S. aureus (and to some extent Streptococcus), while the hydrocortisone acetate reduces the underlying inflammatory response driving the eczema. This dual action often produces faster and more complete clinical resolution than either agent used alone for infected eczema. However, use should be time-limited to minimise the risk of antibiotic resistance and topical steroid side effects.
What Conditions Does Fucidin H Treat?
Fucidin H is prescribed for:
Allergic or irritant contact dermatitis that has become secondarily infected is another common indication. As with infected atopic eczema, the combination of anti-inflammatory and antibacterial activity in a single preparation is clinically advantageous.
Seborrhoeic dermatitis affecting the face, scalp margins, or body folds may become infected with S. aureus, particularly in areas prone to moisture retention or scratching. Fucidin H is appropriate in this setting for short-term treatment.
Where scratching of an insect bite reaction or minor superficial skin inflammation has introduced staphylococcal infection into the compromised skin barrier, Fucidin H provides appropriate combined treatment.
While Fucidin H is effective for managing infected eczema and dermatitis, it should be used cautiously to avoid the risk of antibiotic resistance and side effects from prolonged corticosteroid use.
How Does Fucidin H Work?
Fusidic acid is a steroidal antibiotic with a narrow spectrum of activity predominantly against Gram-positive organisms, particularly S. aureus (including many MRSA strains). It works by inhibiting bacterial protein synthesis through a unique mechanism: it binds to and stabilises the complex between elongation factor G (EF-G) and GDP on the ribosome, preventing translocation of the growing peptide chain during translation. This halts bacterial protein synthesis in a bacteriostatic (and at higher concentrations, bactericidal) manner.
Fusidic acid penetrates skin well and achieves high local concentrations in infected skin tissue. Because resistance to fusidic acid can develop rapidly — particularly with S. aureus — Fucidin H should only be used for short courses and should not be used for prolonged or prophylactic purposes.
Hydrocortisone Acetate (Corticosteroid Component)
Hydrocortisone acetate 1% is a mild potency topical corticosteroid. It binds to intracellular glucocorticoid receptors in epidermal and dermal cells, modulating the transcription of pro-inflammatory genes. This produces local anti-inflammatory effects including: reduction in erythema, oedema, and pruritus; suppression of mast cell activation and mediator release; and inhibition of cytokine production driving the eczematous inflammatory response. At 1% concentration, hydrocortisone acetate is the mildest class of topical corticosteroid and is associated with minimal risk of significant local or systemic steroid side effects with short-term use.
Dosages & Administration
The correct dose depends on the type and severity of infection, age, weight, and kidney function. Always follow your clinician's instructions. The table below is for general reference only.
Administration Tips
Always follow your clinician's instructions. Apply a thin layer of Fucidin H to the affected area twice daily for a maximum of 7 days. Avoid using it for longer than necessary to minimize the risk of resistance and side effects.
Side Effects of Fucidin H
Fucidin H is generally well tolerated, but some side effects may occur.
- Skin burning or stinging on application: Usually mild and transient, particularly if applied to broken or inflamed skin.
- Skin dryness or irritation at application site
- Contact sensitisation to fusidic acid: Allergic contact dermatitis to fusidic acid can develop, characterised by worsening rather than improvement of the skin condition. If the treated area becomes progressively more red, itchy, and inflamed despite treatment, stop Fucidin H and seek clinical review.
- Skin atrophy: With prolonged use of any topical corticosteroid; risk is low with hydrocortisone 1% on short courses but increases significantly with extended use, particularly on thin-skinned areas (face, skin folds, genitalia).
- Perioral dermatitis or acneiform eruption: If used extensively on the face.
- Striae (stretch marks): With prolonged use under occlusion.
Patients should be informed about the risk of developing antibiotic resistance and the importance of not using Fucidin H for uninfected eczema.
Drug Interactions
Fucidin H is a topical preparation with negligible systemic absorption, so significant drug interactions are not expected at standard doses.
Concurrent systemic fusidic acid with statins significantly increases the risk of severe muscle toxicity (rhabdomyolysis). This interaction is mainly relevant to oral or IV fusidic acid, not topical use, but caution is advised if systemic therapy is used.
Concurrent use may increase the risk of excessive corticosteroid exposure, leading to skin thinning (atrophy) or systemic absorption, especially with prolonged use or large application areas.
Use under occlusion may increase systemic absorption of hydrocortisone, increasing the risk of corticosteroid-related adverse effects.
Concurrent topical antibiotics may increase the risk of local skin irritation but generally have minimal systemic interaction risk.
Important Warnings
Fucidin H should not be used for longer than 14 days. Prolonged use increases the risk of developing fusidic acid-resistant S. aureus (a significant public health concern) and topical steroid skin thinning. If skin infection is not improving after 7 days, seek clinical review rather than extending the course independently.
Fucidin H contains a potent antibiotic and should not be used for eczema that is not clinically infected. Overuse of topical fusidic acid is a major contributor to antibiotic resistance on the skin and in the community. Use a plain topical corticosteroid for uninfected eczema flares.
Using Fucidin H on ringworm, athlete's foot, cold sores, or chickenpox is harmful. The corticosteroid component suppresses the immune response and worsens these conditions. If you are unsure whether your skin condition is infected eczema or a fungal/viral infection, seek clinical assessment before using Fucidin H.
Speak to a Clinician About Treatment
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The treatment you need, when you need it.
Fucidin H FAQs
Fucidin H can be used on the face for short courses (no more than 7 days) under clinician direction. However, facial skin is thinner and more sensitive to topical corticosteroid side effects (skin atrophy, perioral dermatitis, rosacea exacerbation). Use the smallest amount necessary, avoid the periorbital area, and never use continuously or as a long-term treatment. If eczema on the face is recurrently infected, discuss long-term management strategies with a clinician rather than relying on repeated Fucidin H courses.
Signs that eczema has become secondarily infected include: a sudden worsening beyond the usual eczema flare, golden or yellow crusting (similar in appearance to impetigo), increased oozing and weeping, pustules, areas that are hot and red beyond the usual eczematous inflammation, and sometimes swollen lymph nodes or fever. If in doubt, a clinician can assess and swab the affected area. Not all flares are infected, and Fucidin H should not be used for non-infected eczema.
Repeated or prolonged use of topical fusidic acid is a major driver of fusidic acid-resistant Staphylococcus aureus on the skin surface. This resistance can spread to other people and makes future treatment of skin infections more difficult. The recommended approach is to use Fucidin H only for confirmed infected eczema episodes, for 7 days at a time, and to focus between infections on optimal eczema management (emollients, soap substitutes, appropriate plain topical corticosteroids) to reduce the frequency of infected flares.
Fucidin H can be used in children under prescription and clinician supervision. The smallest effective amount should be applied for the shortest possible time. Children have a higher body-surface-area-to-weight ratio than adults, meaning systemic absorption of the corticosteroid component is proportionally higher. Avoid use under nappies as the occlusive environment significantly increases absorption. Do not use on large areas of a child's body.