Cushing’s syndrome caused by short-term topical glucocorticoid use for erythrodermic psoriasis and development of adrenal insufficiency after glucocorticoid withdrawal

Topical hesperidin prevents glucocorticoid‐induced abnormalities in epidermal barrier function in murine skin

“…Systemic and topical glucocorticoids (GC) are widely used for treating inflammatory disorders, including a variety of kidney, respiratory, cardiovascular and skin diseases . While systemic or topical GC often demonstrate numerous short‐term benefits, significant side effects, including generalised infections, diabetes, Cushing's syndrome and osteoporosis, can limit their usage . Topical GC are among the most widely used form of anti‐inflammatory therapy in dermatology, but physicians also often are reluctant to deploy them due to their atrophogenic side effects, including skin hypopigmentation, telangiectasia, delayed wound healing and impaired cutaneous innate immunity .…”

Cushing’s syndrome induced by high-potency topical corticosteroids

“…Cushing’s syndrome caused by TC use is more common in infants and usually results from a shorter duration (three months to one year) of use 4,6,7 . The drug therapy period is longer in adults, ranging from 10 months to 12 years, 2,5,8 except in patients with erythrodermic psoriasis, 3 but our patient had used topical steroid ointment for five years. Another noteworthy feature of the cases reported in the literature is that a large number of them derive from Turkey 3,6–9 .…”

“…The drug therapy period is longer in adults, ranging from 10 months to 12 years, 2,5,8 except in patients with erythrodermic psoriasis, 3 but our patient had used topical steroid ointment for five years. Another noteworthy feature of the cases reported in the literature is that a large number of them derive from Turkey 3,6–9 . The fact that patients in Turkey can obtain corticosteroids without a prescription may explain why the country has a large number of cases.…”

“…Like infants, in whom the side effects of TCs develop more easily, patients with chronic diseases that affect large parts of the body surface, such as atopic dermatitis or psoriasis, are at high risk for developing Cushing’s syndrome 2–5 . The most reported corticosteroid is clobetasol dipropionate, 2,4–6 but lower‐potency TCs may cause systemic side effects in infants or patients with abnormal barrier function, such as in erythroderma or in acitretin use 3 . Cushing’s syndrome caused by TC use is more common in infants and usually results from a shorter duration (three months to one year) of use 4,6,7 .…”

Anterior Pituitary Failure

“…This results in eventual adrenal cortex atrophy and failure to maintain normal cortisol levels. Multiple sources of exogenous glucocorticoids have been implicated in causing adrenal insufficiency, including oral, inhaled [84,85], topical [86] and injections [87]. Concomitant retroviral therapy for HIV infection may exacerbate the suppression [87,88].…”