USPharmacist | Case Study | Challenge

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Alternative to Hydrocortisone for
Treatment of Rash

BB is a 62-year-old woman who purchased hydrocortisone 1% topical cream OTC at the pharmacy 2 days ago. BB developed a rash on her lower legs following a family camping trip that was particularly bothersome and “itchy.” BB’s daughter is at the pharmacy today reporting that her mom’s rash has worsened since starting the hydrocortisone cream 2 days prior. BB’s daughter is asking for a recommendation for a different OTC product to treat her mother’s rash in place of the hydrocortisone.

BB is taking the following prescription medications per a review of her profile:

1. Metformin (Glucophage) 1,000 mg BID
2. Glimepiride (Amaryl) 4 mg QD
3. Insulin glargine (Lantus) 20 units QHS
4. Clopidogrel (Plavix) 75 mg QD
5. Amlodipine (Norvasc) 10 mg QD
6. Metoprolol (Toprol XL) 25 mg QD
7. Furosemide (Lasix) 80 mg QD
8. Potassium chloride 20 mEq QD
9. Esomeprazole (Nexium) 20 mg QD
10. Zolpidem (Ambien) 5 mg QHS PRN

Upon further discussion, BB’s daughter states that she is concerned that her mother has had an allergic reaction to the hydrocortisone cream, thus she would like another product that will not make the rash worse. BB’s daughter is not sure if her mother has used hydrocortisone cream in the past and was unable to reach her mother by phone to ask. Overnight BB has developed acute pain in her left ankle and developed a fever of 102 degrees. Per her daughter, BB’s medical history is positive for type 2 diabetes, coronary artery disease, and hypertension. When asked about other OTC medication use, she reported that her mother uses Lamisil AT Athlete's Foot Spray. She additionally shared that BB’s blood sugar readings have been increasing steadily over the last several days, with her blood glucose measuring 235 mg/dL this morning.

Based on this information, what recommendation would you have for BB’s daughter regarding her request for another OTC product to treat her mother’s rash?

Joshua J. Neumiller, PharmD, CDE, CGP, FASCP
Assistant Clinical Professor
Washington State University
Spokane, Washington

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