Hypothalamic–Pituitary–Adrenal Axis Suppression Related to Topical Glucocorticoid Therapy in a Child with Psoriatic Exfoliative Erythroderma

Abstract

Exfoliative erythroderma is a rare presentation of psoriasis in children and adults. We report a 9-year-old girl with exfoliative erythroderma secondary to plaque-type psoriasis who developed hypothalamic-pituitary-adrenal axis suppression resulting from topical treatment with a medium-potency glucocorticoid. This case emphasizes the need for awareness of this potentially life-threatening complication of topical glucocorticoid use, particularly in patients who have significant compromise of barrier function secondary to widespread skin disease.

Psoriatic erythroderma and hypothalamus-pituitary axis suppression due to misuse of systemic steroid: Two challenging cases

“…Withdrawal of steroid in a patient of psoriasis on long term corticosteroid is known to rebound with pustular erythroderma. [ 14 ] In a case report by Campbell et al .,[ 10 ] a 9-year-old Mexican-American girl developed HPA axis suppression following application of medium strength topical glucocorticoid to large areas of her body surface for one month. Control of her skin disease required systemic therapy using cyclosporine and etanercept.…”

“…[ 1 2 3 4 5 ] There are many reports of topical corticosteroid used in psoriasis leading to iatrogenic Cushing's syndrome. [ 6 7 8 9 10 ] Even the report of Cushing's syndrome with herbal remedy containing betamethasone is found in the literature. [ 11 ] However, to our knowledge self-medication of systemic corticosteroid or homeopathic pills containing betamethasone in psoriasis leading to cushingoid features and suppression of HPA axis is nil.…”

Maximal Usage Trial: An Overview of the Design of Systemic Bioavailability Trial for Topical Dermatological Products

“…The classic example of this is hypothalamic-pituitary-adrenal axis suppression due to the use of potent topical corticosteroids. [1][2][3] Since the mid-1970s, as part of the evaluation of any drug product, sponsors have been required to investigate the in vivo bioavailability of their products. 4,5 For topically applied products, this has not always been possible due to limitations in analytical methods and an uncertainty in appropriate subject selection and trial design.…”

“…The classic example of this is hypothalamic-pituitary-adrenal axis suppression due to the use of potent topical corticosteroids. 1 –3…”