Endocrine Abstracts

Background: Topical corticosteroids are frequently prescribed by dermatologists and primary care physicians. They are the most commonly prescribed medications in dermatology practice due to their anti-inflammatory and immunosuppressive properties. If used within a therapeutic window they are safe and effective, and their adverse effects are rare. Prolonged use even with topical agents can result in both local and systemic side effects. However, patients are often unaware of their serious and potentially fatal systemic side effects if used incorrectly. Our patient illustrates the dangers of using topical steroids for prolonged periods particularly if applied over a wide surface area.

Clinical case: The Patient is a 52-year-old female who had been diagnosed with Steroid dependent Pemphigus Foliaceus since October 2020 and was on long term topical steroids and intermittent courses of oral steroids. In January 2022, she developed an Addisonian crisis which was treated and managed at Nottingham University Hospital. She had a Cushingoid appearance with thinning of the skin, BMI 28.2 kg/m2 but a normal blood pressure. Her 9AM cortisol was low with suppressed ACTH level suggesting that the patient had been receiving supraphysiological doses of steroids. To prevent adrenal crisis and to treat secondary adrenal insufficiency, the patient was on replacement doses of oral hydrocortisone (10 mg/5 mg/5 mg). Advice was given to wean off topical steroids whilst on the physiological doses of steroids. She was started on Tacrolimus instead of steroids for Pemphigus Foliaceus.

Conclusion: Primary care physicians and dermatologists usually warn patients about the potential side effects if used excessively or incorrectly in order to avoid the occurrence of local and systemic side effects, which could be fatal. However, the hazard of using topical steroids in dermatological conditions with a greater absorption if applied over a wide area of skin which can increase the risk of systemic effects can be overlooked.