Scleroderma Renal Crisis Following Widespread Application of Topical Triamcinolone

Abstract

A 52-year-old patient with early diffuse scleroderma (Scl) developed scleroderma renal crisis (SRC) following exposure to topical steroid cream. She had applied a larger-than-prescribed quantity of triamcinolone acetonide 0.1% cream all over her body for 3 months, the absorption of the cream being the equivalent of 7.5 mg of oral prednisone per day. Her SRC was subsequently managed successfully with aggressive antihypertensive therapy and hemodialysis, and she was discharged home. High-dose corticosteroids (CS) have long been implicated in the development of SRC, but topical and low-dose CS until now have not. In our opinion, low-dose CS and a predisposing clinical setting appeared sufficient to provoke SRC and may broaden the proscription against CS in Scl.

Scleroderma Renal Crisis: A Pathology Perspective

“…The latter is usually associated with systemic steroid administration [20]. However, rare cases of SRC have been described following topical steroid use [21]. In patients with SRC, presenting normal or mildly elevated blood pressures (normotensive SRC), older age and male sex have been suggested to be adverse prognostic factors [18].…”