Iatrogenic Cushing Syndrome due to Application of Potent Topical Corticosteroid: A Case Report

Alark Rajouria,Eliz Aryal,Mohan Bhusal,Sabina Bhattarai,Sanju Babu Shrestha

doi:10.3126/njdvl.v17i1.23291

Abstract

Corticosteroids are over the counter and cheaper drugs available in every medical stores in Nepal. Iatrogenic Cushing syndrome due to topical steroids application is a very rare phenomenon in adults.A 32 year female from Janakpur presented with complaints of swelling of face, weight gain, excessive facial hair and fatigue since two years that gradually increased over last one year. She had a past medical history of on and off application of multiple potent topical corticosteroids for disseminated Tinea infection. She was obese with moon facies, buffalo hump and multiple striae over her abdomen. Her blood pressure was raised and her blood sugar was in pre-diabetic range. Laboratory studies were consistent with iatrogenic Cushing syndrome. Patient recovered after discontinuation of topical corticosteroids and treatment with antifungals.Although iatrogenic Cushing syndrome following application of topical corticosteroid is a rare phenomenon in adults, this can happen in a setup like ours where corticosteroids are prescribed as over the counters and patients have very little knowledge about their use. Therefore, we emphasize that patients and pharmacist should be well educated about the consequences of their prolong application and their side effects

Highlights

Corticosteroids are anti-inflammatory group of drugs prescribed for a wide range of dermatological conditions e.g. Eczemas, Psoriasis, Bullous Dermatosis, Connective tissue diseases, Vasculitis etc.[1]
Topical Corticosteroids are over the counter and cheaper drugs available in every medical stores in Nepal and India and often misused for treatment of Dermatophytic infections, Eczemas, Acne, undiagnosed skin rashes and as fairness cream by non-registered practitioners/ chemist.[2,3,4]
We report a case of a 32 year female with iatrogenic Cushing syndrome

Summary

Introduction

32 year old female from Janakpur presented at Nepal Diabetes Thyroid Endocrinology and Physician Center. Bhusal M, et al Iatrogenic Cushing Syndrome (NDEP), New Baneshwor, Kathmandu with swelling of face, weight gain, excessive facial hair, generalized fatigue and weakness of arms since two years that gradually increased over the last one year She had a past medical history of repeated application of multiple potent topical corticosteroids for disseminated tinea infection since nine years and more intense and regular application of clobetasol propionate 0.05% cream for last one year (approximately 56 tubes of 30 g in last 6 months; i.e 70 g per week). Hypertrichosis (fig.3.), buffalo hump (fig.3.) and multiple striae (fig.1.) over abdomen were present On investigation her HbA1c was 6.1% (N: 4-5.6), 8 am cortisol was 0.32 μg/dl (6.9-22.6 μg/dl),[4] pm cortisol was 0.48μg/dl (6.7-22.6 μg/dl ); 24 hour urinary cortisol was 9.5 μg/dl (20.9-290.3 μg/dl) and ACTH was 17.1pg/ml (≤46 pg/ml). The HbA1c and 8 am cortisol normalized to 5.2% and 9.66 μg/dl respectively

Findings

Discussion

Conclusion