Iatrogenic Cushing syndrome due to topical glicocorticosteroid therapy

Abstract

Topical glicocorticosteroids are the most common drugs to treat acute and chronic inflammatory skin diseases. Prolonged use of them may cause systemic adverse effects including Cushing's syndrome and hypothalamic-pituitary-adrenal axis suppression. We present a case of four year old girl who developed iatrogenic Cushing syndrome and adrenal insufficiency after atopic dermatitis treatment through the misuse of Mometasone treatment without doctor's prescription. We observe a reddness and a moon face, a buffalo hump, central obesity, ginecomasty, subcutaneous hypertrophy, hirsutism, buttocks muscle atrophy and growth retardation. Wrist X-Ray revealed a bone age of two year old child. Laboratory values revealed hypothalamic-pituitary-adrenal axis suppression. The discontinuation of Mometasone treatment and supplement treatment with oral Hydrocotisone three times per day proved successful in this patient. For this case, the serious side effects of topical glucocorticosteroid treatment should be explained to the family and their long-term therapy should be refrained. Iatrogenic Cushing syndrome in childchood caused by topical treatment is a rare event.

Topical corticosteroid abuse – a prospective clinico-epidemiological study

“…A significant number of patients (16%, n=32) were using the irrational over-the-counter three or four drug combinations which include a corticosteroid, an antibiotic and an antifungal, while 20% (n=40) were using the variants of Kligman's formula (corticosteroid, hydroquinone, tretinoin) for pigmentation. The inappropriate use of TCs can lead to multiple side effects including atrophy, striae, telengiectasis, purpura, hypopigmentation, acneiform eruptions, rosacea-like perioral and periorbital dermatitis and hypertrichosis and even iatrogenic Cushing's syndrome [5,[7][8][9]. In our study, 43.5% (n=87) patients presented with cutaneous adverse effects of TCs, the most common ones being tinea incognito (24%), steroid acne (16%), steroid rosacea (11%), hypertrichosis (6%) and striae (4%).…”

Η Διερεύνηση Γνώσεων Γονέων Παιδιών Με Δερματοπάθειες Για Χρήση Βιολογικών Σε Σύγκριση Με Χημικά Προϊόντα

“…Σύμφωνα με τη διεθνή βιβλιογραφία η παρατεταμένη αλλά και αλόγιστη χρήση των τοπικών κορτικοστεροειδών μπορεί να επιφέρει ανεπιθύμητες ενέργειες (π.χ. σύνδρομο Cushing) στα παιδιά που πάσχουν από διάφορα είδη δερματοπαθειών όπως η δερματίτιδα εκ σπαργάνων ή η ατοπική δερματίτιδα 81,112. Από τη διεθνή βιβλιογραφία προέκυψε ότι τα χημικά μη κορτικοστεροειδή προϊόντα χρησιμοποιούνται ως αποτελεσματική υποστηρικτική θεραπεία (δεύτερη γραμμή θεραπείας) αντιμετώπισης των δερματοπαθειών των παιδιών.…”