Overt Diabetes Mellitus Caused by the Topical Administration of Dexamethasone Ointment on the Oral Mucosa

Abstract

We herein describe the case of a 68-year-old man who developed overt diabetes mellitus following the topical administration of dexamethasone 0.1%-containing ointment over a five-month period to treat oral lichen planus. The topical dexamethasone therapy was discontinued gradually, and the patient was subsequently treated with insulin for one month without clinical signs of overt adrenal insufficiency. An oral glucose tolerance test revealed impaired glucose tolerance after the treatment. The potential for the deterioration of glucose metabolism must be considered when patients with impaired glucose tolerance are treated with relatively low doses of topical corticosteroid ointment on the oral mucosa, even for short periods.

Acute Hyperglycemia Due to Topical Corticosteroid Administration

“…Kahara et al reported the case of a patient treated for oral lichen planus with a class VII (lowest potency) steroid on his oral mucosa. The patient developed new onset diabetes that required initiation of an oral anti-diabetes medication for several months (Table 1) [4]. A nested case-control study of over 192,000 patients in the Netherlands found a 1.24-fold increased risk of developing diabetes among those currently using topical corticosteroids.…”

Topical Glucocorticoid Use and the Risk of Posttransplant Diabetes

“…The study was based on high-quality databases including both case-control and cohort studies, providing a large number of subjects and information on confounding comorbidities with the exclusion of diseases related to insulin resistance and DM. However, unlike orally administered glucocorticoids, the absorption rate of TS differs depending on the administration area and the condition of the layers of the skin [ 23 , 29 ]. The authors were unable to differentiate between these factors, resulting in potential bias.…”

“…Kahara et al reported a patient receiving class VII (lowest potency) TS applied to the oral mucosa for several months to treat lichen planus. The patient developed new-onset diabetes requiring the initiation of oral antidiabetic medication [ 23 ]. Sue and Milanesi described a patient with known type 1 DM admitted with acute hyperglycemia and required five times his typical daily insulin dose after only two days of occlusive treatment with class I TS on a large area of his body for psoriasis [ 22 ], similar to our case.…”

“…Only a few cases of new-onset DM following TStreatment have been published [22][23][24][25]. Kahara et al reported a patient receiving class VII (lowest potency) TS applied to the oral mucosa for several months to treat lichen planus.…”

“…Signifcant associations between TS and the risk of T2D have been shown in previous, retrospective studies [19][20][21]. Te magnitude of this risk remains uncertain, and only a few case reports have described the use of TS resulting in overt T2D [17,[22][23][24][25].…”