Iatrogenic adrenal insufficiency associated with calcipotriol–betamethasone topical combination in psoriasis

Topical corticosteroids in plaque psoriasis: a systematic review of risk of adrenal axis suppression and skin atrophy

“…When it comes to systemic side effects, reversible hypothalamic‐pituitary‐adrenal (HPA) axis suppression was reported rarely 26,27 compared with the large population of patients treated with topical steroids for psoriasis worldwide. All cases of prolonged HPA axis suppression are characterized by misuse of topical steroids: prolonged daily application over several years on large surfaces 28 . Although transient reduction of HPA axis function can be observed in up to 48% of patients, 24 this reduction is reversible and not usually associated with clinical symptoms even during long‐term maintenance treatment.…”

“…All cases of prolonged HPA axis suppression are characterized by misuse of topical steroids: prolonged daily application over several years on large surfaces. 28 Although transient reduction of HPA axis function can be observed in up to 48% of patients, 24 this reduction is reversible and not usually associated with clinical symptoms even during long-term maintenance treatment. In short-term studies, reduction of cortisol plasma levels was mainly recorded early in the course of the treatment i.e.…”

Trends in hospitalization rates for psoriasis flares since the introduction of biologics: a time series in France between 2005 and 2015

“…showed that 50% of patients expressed a 3‐year or longer duration of uncontrolled psoriasis before the decision to initiate systemic therapy is taken by a physician. Many patients with severe psoriasis have a misuse of topical treatment . Using biologics earlier may improve the care of patients and reduce the number of hospitalisations for psoriasis flares.…”

“…Many patients with severe psoriasis have a misuse of topical treatment. 29,30 Using biologics earlier may improve the care of patients and reduce the number of hospitalisations for psoriasis flares.…”

Psoriatic erythroderma and hypothalamus-pituitary axis suppression due to misuse of systemic steroid: Two challenging cases

“…[ 1 2 3 4 5 ] There are many reports of topical corticosteroid used in psoriasis leading to iatrogenic Cushing's syndrome. [ 6 7 8 9 10 ] Even the report of Cushing's syndrome with herbal remedy containing betamethasone is found in the literature. [ 11 ] However, to our knowledge self-medication of systemic corticosteroid or homeopathic pills containing betamethasone in psoriasis leading to cushingoid features and suppression of HPA axis is nil.…”