A florid case of Iatrogenic Cushing′s syndrome induced by topical steroid with osteoporosis and hypogonadism

Sahana, Pranab Kumar; Sarma, Nilendu; Sengupta, Nilanjan; Somani, Prashant Subhash

doi:10.4103/0019-5154.160514

Cited by 6 publications

(4 citation statements)

References 9 publications

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“…Hypertension due to prolonged topical CS has been rarely reported in literature 27 . Our patient also developed osteopenia without growth impairment because of prolonged use of topical CS; which was evident on DEXA scan, which has been previously reported 28‐30 …”

Section: Discussionsupporting

confidence: 75%

“…27 Our patient also developed osteopenia without growth impairment because of prolonged use of topical CS; which was evident on DEXA scan, which has been previously reported. [28][29][30] Grodner et al 31 studied the effect of initiation of systemic treatment for psoriasis and found that there was a marked reduction in the consumption of topical steroids when treatment with conventional agents (cyclosporin, methotrexate, acitretin) and biologics was initiated. Hence it can be inferred that early systemic treatment reduced the consumption of topical corticosteroids.…”

Section: Development Of Disseminated Viral Infection After Prolongedmentioning

confidence: 99%

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Iatrogenic Cushing's syndrome due to topical steroid abuse in a child with Psoriasis presenting as septicaemia

Sachdeva

Arora

Kulhari

et al. 2020

Dermatologic Therapy

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Psoriasis vulgaris is a chronic inflammatory disorder that affects the skin and joints. Mild disease is treated with topical corticosteroids (CS) which forms the first line of treatment for localized disease. While it is well established that prolonged use of oral or parenteral corticosteroids can lead to iatrogenic Cushing's syndrome and suppression of hypothalamic pituitary axis; development of these complications secondary to use of topical CS is rarely described. Since steroids have anti‐inflammatory properties, their prolonged use can lead to increased susceptibility to develop bacterial and fungal infections. We hereby report a 11‐year‐old female with psoriasis who presented with septicaemia and features of iatrogenic Cushing's syndrome due to treatment with topical corticosteroids for 2 years. Presentation of ICS as septicemia due to topical steroid use in this age group or in a psoriatic patient has not been described in the literature so far. Patient also developed hypertension and osteopenia, which are known adverse effects of corticosteroids; but occur rarely due to topical corticosteroids.

show abstract

Section: Discussionsupporting

confidence: 75%

Section: Development Of Disseminated Viral Infection After Prolongedmentioning

confidence: 99%

Iatrogenic Cushing's syndrome due to topical steroid abuse in a child with Psoriasis presenting as septicaemia

Sachdeva

Arora

Kulhari

et al. 2020

Dermatologic Therapy

View full text Add to dashboard Cite

show abstract

“…Other causes of bone pain, such as joint laxity, and primary bone disorders were excluded. One case history was found reporting a similar incidence of osteoporosis in relation to topical steroid use, with evidence of systemic bioavailability evident in suppression of the hypothalamic-pituitary axis, affecting both growth and puberty [ 3 ]. In resemblance, the patient was an adolescent male who suffered from generalised pustular psoriasis and was prescribed a potent topical steroid, clobetasol propionate.…”

Section: Discussionmentioning

confidence: 99%

“…While the deleterious effect of low-dose systemic corticosteroids on bone homeostasis has long been established [ 2 ], a considerable degree of uncertainty is still yet to be unraveled as to the effect of topical corticosteroids. Children in particular are more prone to the development of systemic adverse effects relating to topically applied corticosteroids due to their higher ratio of total body surface area to total body weight [ 3 ]. This brings attention to the variables that would determine the likelihood of osteoporosis in children treated with topical steroids.…”

Section: Introductionmentioning

confidence: 99%

Implication of Topical Steroids in the Onset of Osteoporosis

Milyani

Al-Agha

2018

Case Reports in Pediatrics

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The systemic bioavailability of steroids has long been implicated as a cause for osteoporosis (OP); however, much less is known about the effect of topical steroids on bone homeostasis. This is a case of an 11-year-old male who is a known case of generalised pustular psoriasis for 8-year duration with frequent exacerbations controlled with topical betamethasone dipropionate. He presented with generalised progressive bone pain and positive history of bone fracture. The diagnosis of OP was established on the results of DEXA, which were −2.7 SD and −2.4 SD for the lumbar spine and whole body, respectively. Although the cutoff value is the same (<−2 SD) in children, the definition of OP is more reliant on the densitometry Z score, as opposed to adults, who are approached using the T score. The element of psoriasis poses a risk for the development of OP due to the presence of a chronic inflammatory disease state that increases bone turnover. Furthermore, the compromised skin barrier and associated vasodilation seen in psoriasis enhance the absorption of topically applied agents and increase their bioavailability. Children are a targeted risk group as they are more vulnerable to the manifestation of systemic adverse affects of topically applied steroids as a result of their increased ratio of total surface area relative to their body weight and slower drug metabolism. We recommend that children undergoing long-term topical steroid therapy be screened for OP with the consideration of instituting prophylactic treatment especially in those suffering from chronic inflammatory disease states.

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Keratoconus: a potential risk factor for osteoarthritis

Bozkurt

Bağcıer

2020

Int Ophthalmol

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A florid case of Iatrogenic Cushing′s syndrome induced by topical steroid with osteoporosis and hypogonadism

Cited by 6 publications

References 9 publications

Iatrogenic Cushing's syndrome due to topical steroid abuse in a child with Psoriasis presenting as septicaemia

Iatrogenic Cushing's syndrome due to topical steroid abuse in a child with Psoriasis presenting as septicaemia

Implication of Topical Steroids in the Onset of Osteoporosis

Keratoconus: a potential risk factor for osteoarthritis

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