Iatrogenic Cushing′s syndrome after topical steroid therapy for psoriasis

Abstract

Glucocorticoids are used for the treatment of many diseases, such as inflammatory, allergic, autoimmune, and neoplastic diseases. They can be used in the form of topical, oral, inhalable, rectal, and intra-articular agents. Many topical steroid-related iatrogenic Cushing's syndrome cases affecting especially children have been reported in the literature. Topical steroid-related Cushing's syndrome is rarely seen in adults. In this report, we present the case of a 32-year-old male patient with iatrogenic Cushing's syndrome related to long-term clobetasol propionate treatment for psoriasis. In the context of such treatment, the glucocorticoid withdrawal problem has to be overcome. At present there is no consensus on steroid withdrawal. Patients on long-term glucocorticoid treatment must be evaluated for potential adverse effects and withdrawal symptoms by their physician and their endocrinologist.

Iatrogenic Cushing’s Syndrome with Subsequent Adrenal Insufficiency in a Patient with Psoriasis Vulgaris Using Topical Steroids

“…Local adverse effects of topical steroids are acne, purpura, atrophy, striae, and telangiectasia. ICS and hypothalamic-pituitary-adrenal (HPA) axis suppression are rare but unignorable complications of topical steroids [ 1 , 4 – 6 ]. ICS patients may present with purple striae, central obesity, hypertension, buffalo hump, muscle weakness, moon face, hirsutism, and easy bruising of skin like in our patient [ 1 , 4 – 6 ].…”

“…PV is chronic inflammatory disease and characterized by periods of attack and remission [ 4 – 6 ]. TS is the first choice of treatment for localized and mild PV [ 4 , 5 ].…”

“…PV is chronic inflammatory disease and characterized by periods of attack and remission [ 4 – 6 ]. TS is the first choice of treatment for localized and mild PV [ 4 , 5 ]. In the literature, patients with ICS associated with TS are more frequent in the pediatric age group due to thinner dermis layer of skin and higher surface/volume ratio leading to more absorption rate through the skin [ 2 , 3 ].…”

“…In the literature, patients with ICS associated with TS are more frequent in the pediatric age group due to thinner dermis layer of skin and higher surface/volume ratio leading to more absorption rate through the skin [ 2 , 3 ]. ICS rarely occurs through the topical administration in adults [ 1 , 4 , 5 ]. In the literature, the risk of developing steroid-induced ICS is reported to be associated with the age of the patient, size and localization of lesions, the epithelium integrity, individual metabolic variation, duration of use, powder of drug, duration of therapy, and the sensitivity of steroid receptors [ 1 ].…”

“…Since children have thinner dermis layer of epidermis than adults with a higher surface/volume ratio steroids are more absorbed through the skin of children leading to systemic side effects [ 2 , 3 ]. In the literature, there are a few adult cases who developed ICS and secondary adrenal insufficiency associated with TS [ 1 , 4 , 5 ]. In this case report, a male patient with psoriasis vulgaris (PV) developing ICS after treatment of TS for 12 years is presented.…”