Cushing's Syndrome Induced by Misuse of Moderate- to High-Potency Topical Corticosteroids

OBJECTIVE: To report a case of Cushing's syndrome caused by continuous use of moderate-to high-potency topical corticosteroids over several months. CASE SUMMARY: An 11-month-old patient with atopic dermatitis received uninterrupted treatment with moderate-to high-potency topical corticosteroids. 1 to the hospital after He presented with several food allergies and was admitted atopic dermatitis worsened. Signs of growth retardation, which had begun at 6 months of age, were also noted during the child's hospital stay. An endocrinologist concluded that a lower-than-normal bone density scan and growth retardation on both weight and growth curves were due to suppression of the hypothalamic-pituitary-adrenal (HPA) axis and a multifactorial failure to thrive. DISCUSSION: This is a case of an infant overexposed to topical corticosteroid treatment who developed Cushing's syndrome within a few months. Local treatment treatment who developed Cushing of atopic dermatitis is classically based on the use of topical corticosteroids in combination with an emollient or other drugs. To limit local and general damaging effects, the choice of topical corticosteroid must be made in terms of patient age, severity and site of the rash, and the extent of skin involvement. Several factors influence the systemic absorption of topical corticosterolds. While our literature's growth review indicated the possibility of a multifactorial origin of the child retardation, the use of topical corticosteroids was shown to have contributed to suppression of the HPA axis. Application of the Naranjo probability scale indicated a probable relationship between the continuous and sustained administration of topical corticosteroids over several months and suppression of the HPA axis. Although topical corticosterolds are widely used and can be perceived by parents and patients to be safe, daily documentation of agents used and body surfaces exposed should be done during long-term treatment. CONCLUSIONS: Continuous use of moderate-to high-potency topical corticosteroids over several months can contribute to Cushing's syndrome. Growth and development as well as cortisol levels should be monitored in children on longterm topical corticosteroid treatment.