Endocrine Abstracts

Topical application of corticosteroids is frequently used in the therapy of dermatological diseases due to their anti-inflammatory and immunosuppressive effects. On the other hand, when reaching pharmacological levels, exogenous corticoids frequently lead to complete Cushing syndrome, including skin modifications, irrespective of the route of administration. We describe four cases of iatrogenic Cushing’s syndrome triggered by topical application of corticoids. The first two cases are those of VM, a 4-month-old girl and DAR, a 2-year-old boy treated for eczema with clobetasolum propionate for 2 and 6 months, respectively. The third case is a 51-year-old woman, BE, who also used clobetasolum propionate and applied it to generalized lesions of psoriasis for more than 1.5 years. Both children and patient BE developed overt iatrogenic Cushing’s syndrome, with centripetal obesity, typical cutaneous modifications and significant behaviour disturbances. Low morning plasma cortisol, urinary cortisol and ACTH confirmed the exogenous nature of hypercorticism. The children’s growth was slowed during therapy, with significant delay seen in DAR (−3 S.D.) BE developed insulin-necessitating diabetes mellitus and hypertension. Therapy arrest provoked prolonged hypocorticism with asthenia, depression and low blood pressure in DAR and BE. The fourth patient, AN, an obese 24 year old male adult, used topical axillary application of flumetasone pivalate for hydrosadenitis. This patient developed cutaneous changes suggestive of Cushing’s syndrome that were limited to the surface of the application and showed no pathological modifications of the corticotrophic axis or corticoid-related complications. Iatrogenic Cushing syndrome from topical application is common in children, but rare in adults. Individual sensitivity, local absorption capacity and the particularities of the topical corticoid used may all be responsible for the large variety of corticoid-related side effects in patients using topical corticoid therapy. Therapy should not be abruptly interrupted, but rather tapered for avoiding transient adrenal insufficiency.