Iatrogenic Cushing Syndrome due to Application of Potent Topical Corticosteroid: A Case Report

Corticosteroids are over the counter and cheaper drugs available in every medical stores in Nepal. Iatrogenic Cushing syndrome due to topical steroids application is a very rare phenomenon in adults.A 32 year female from Janakpur presented with complaints of swelling of face, weight gain, excessive facial hair and fatigue since two years that gradually increased over last one year. She had a past medical history of on and off application of multiple potent topical corticosteroids for disseminated Tinea infection. She was obese with moon facies, buffalo hump and multiple striae over her abdomen. Her blood pressure was raised and her blood sugar was in pre-diabetic range. Laboratory studies were consistent with iatrogenic Cushing syndrome. Patient recovered after discontinuation of topical corticosteroids and treatment with antifungals.Although iatrogenic Cushing syndrome following application of topical corticosteroid is a rare phenomenon in adults, this can happen in a setup like ours where corticosteroids are prescribed as over the counters and patients have very little knowledge about their use. Therefore, we emphasize that patients and pharmacist should be well educated about the consequences of their prolong application and their side effects

Download Full-text

Cushing Syndrome due to Inappropriate Corticosteroid Topical Treatment of Undiagnosed Scabies

Tropical Medicine and Infectious Disease ◽

10.3390/tropicalmed3030082 ◽

2018 ◽

Vol 3 (3) ◽

pp. 82 ◽

Cited By ~ 4

Author(s):

Guadalupe Estrada-Chávez ◽

Roberto Estrada ◽

Daniel Engelman ◽

Jesus Molina ◽

Guadalupe Chávez-López

Keyword(s):

Risk Factor ◽

Topical Treatment ◽

Cushing Syndrome ◽

Important Risk Factor ◽

Topical Steroids ◽

Over The Counter ◽

Inappropriate Use ◽

Topical Corticosteroids ◽

Lack Of Information

The uncontrolled sale of topical corticosteroids has become an important risk factor for the development of iatrogenic Cushing syndrome in children, especially in countries where medications are sold over the counter. This is exacerbated by the lack of information for both the patients and pharmacists. This report documents a series of eight cases of iatrogenic Cushing syndrome secondary to an inappropriate use of topical steroids, due to a misdiagnosis of scabies.

Download Full-text

A Case of Supplement-Induced Hepatotoxicity

Case Reports in Medicine ◽

10.1155/2010/262706 ◽

2010 ◽

Vol 2010 ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

Fong-Kuei Frank Cheng ◽

Peter Dunaway

Keyword(s):

Abdominal Pain ◽

Liver Disease ◽

Liver Injury ◽

Dietary Supplements ◽

Medication Use ◽

Over The Counter ◽

Caucasian Male ◽

History Of ◽

One Year ◽

Specific Agent

A 45-year-old Caucasian male presented with a two-week history of jaundice and right-upper quadrant (RUQ) abdominal pain. Transaminases and biliary enzymes were markedly elevated with hyperferritinemia and mildly elevated INR. Imaging tests showed no significant abnormality. He denied prescription or over-the-counter (OTC) medication use, but he had been taking at least 9 dietary supplements for 12 months. Other causes of liver disease were excluded. His supplements were discontinued, and his liver-associated enzymes significantly markedly improved over the next 6 weeks and remained normal after one year suggesting supplement-induced hepatotoxicity. Due to the number of supplements, no specific agent could be identified as the primary cause of his liver injury. This case illustrates the importance of inquiring and educating patients of the potential harmful risks of over-the-counter medications and supplements.

Download Full-text

Topical corticosteroids induced hyper-pigmentation: a case report

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20194689 ◽

2019 ◽

Vol 5 (4) ◽

pp. 889

Author(s):

Bhawna Saini ◽

Mohit Kumar ◽

Arkapal Bandyopadhyay

Keyword(s):

Hair Growth ◽

Skin Condition ◽

Facial Hair ◽

Topical Corticosteroids ◽

Itch Sensation ◽

Drug History ◽

Common Skin ◽

History Of ◽

Acne Treatment ◽

Emollient Cream

Hyper-pigmentation is a common skin condition in which increased melanin production results in darker patches of skin. Although hyper-pigmentation is harmless but still mostly people wish to get rid of them because of increasing craze of beautification in India. Topical corticosteroids (TC) application showed quick amelioration of post-inflammatory hyper-pigmentation patches. Prolonged and unsupervised use of TC leads to skin atrophy and reappearance of hyper-pigmentation patches. We present two cases of hyper-pigmentation induced by TC misuse. In case-1, a 20 year old female came to OPD with a complaint of hyper-pigmentation and itch sensation along with drug history of Betnovate cream for the last 2 years for acne treatment. On examination, she showed signs of hyper-pigmentation on cheeks. She was counselled to stop the further use of Betnovate cream and prescribed demelanizing agents along with sunscreen and emollients. The patches improved significantly with above management within 15 days. In case-2, a 33 year old female came to OPD with complaints of redness over whole face, increased facial hair growth and burning sensation along with drug history of using Betnovate cream for 2 years. On examination she showed signs of hyper-pigmentation and redness on cheeks, bruise and tearing of skin and increased facial hair growth. She was counselled to stop the further use of Betnovate cream. She was prescribed retinoic acid cream, sunscreen agents, anti-allergic tablets and emollient cream. The patches improved significantly with above management within 15 days.

Download Full-text

Misuse of topical corticosteroids and attitude towards self-medication: a rising alarm

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20175370 ◽

2017 ◽

Vol 3 (4) ◽

pp. 485

Author(s):

Savita Chaudhary

Keyword(s):

Indian Population ◽

Topical Steroid ◽

Medical Practitioner ◽

Topical Steroids ◽

Self Medication ◽

Topical Medication ◽

Inappropriate Use ◽

Topical Corticosteroids ◽

Number Of Patients ◽

History Of

Background:Topical corticosteroids (TC) are among the most commonly used medications for treatment of skin disorders. They give immediate relief from symptoms in many inflammatory dermatoses. Even inappropriate use in infectious dermatoses relieves the symptoms. This study was done to analyze the misuse of topical corticosteroids in Indian population and to analyze the attitude of patients towards self-medication.Methods:All patients presenting with various dermatoses to the investigator were asked about history of usage of any topical medication on the lesion. In case of a positive answer, the investigator ascertained whether the topical medication in question contained a corticosteroid. The total number of patients seen during the recruitment period (January 2012 – December 2012) was noted on a separate list. Full questionnaires were only filled for patients with history of using topical corticosteroids.Results:5256 patients were screened out of which 4100 (78%) were already using topical medications. 3154 (60%) patients were using topical steroid in various forms. About 80% of the patients using topical steroids confessed that they have not consulted qualified medical practitioner. They were advised these medications by chemists, friends or quacks, neighbours, barbers, beauticians etc.Conclusions:Misuse of topical corticosteroids is common in Indian population and results in various complications. Educating public, chemists, general practitioners along with strict vigil by law enforcing agencies is needed for optimal and safe use of corticosteroids.

Download Full-text

Topical corticosteroid abuse on face: a clinical study of 100 patients

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20163105 ◽

2016 ◽

Vol 2 (3) ◽

pp. 40 ◽

Cited By ~ 4

Author(s):

Pooja Bains

Keyword(s):

Clinical Study ◽

General Population ◽

Adverse Effects ◽

Topical Corticosteroid ◽

Clobetasol Propionate ◽

Age Group ◽

Minimum Period ◽

Topical Corticosteroids ◽

The Face ◽

History Of

Background: Prolonged and uninterrupted use of topical corticosteroids on face is globally prevalant and this misuse has reached monstrous proportion in India. The topical corticosteroid abuse leads to various local adverse effects on face which are difficult to treat. The aim of this study was to ascertain the magnitude, demographics, cause and adverse effects of TC abuse on the face in the dermatology out-patient department.Methods: A total of 100 patients with history of topical corticosteroid abuse on face for a minimum period of one month were enrolled in this study.Results: In our study, majority of the patients were females (76%) and the most common age group was 21-30 years with 49% patients. The duration of application was <6 months (45%) in majority of patients. Most common topical corticosteroids abused were betamethasone valerate in 49% and clobetasol propionate in 40% cases.Conclusions: Topical corticosteroid abuse on face is quite common with varied presentation. There is need to take urgent remedial steps and increase awareness about this problem in general population.

Download Full-text

Improper Use of Topical Corticosteroids in Tinea Infections in a Tertiary Care Hospital

Journal of Nepal Health Research Council ◽

10.33314/jnhrc.v19i1.3105 ◽

2021 ◽

Vol 19 (1) ◽

pp. 71-75

Author(s):

Sushil Paudel ◽

Niraj Parajuli ◽

Sudip Chandra Dahal ◽

Sudarshan Paudel

Keyword(s):

Tertiary Care ◽

Topical Steroids ◽

Care Hospital ◽

Over The Counter ◽

Dermatology Department ◽

Topical Corticosteroids ◽

Regulatory Guidelines ◽

Improper Use ◽

Tinea Incognito ◽

Topical Medications

Background: Steroid-modified tinea, also known as tinea incognito, is an infection by the dermatophytes, where the clinical morphology is modified due to corticosteroids, either systemic or topical. Rampant use of topical corticosteroids has led to increasing recurrence in tinea infections. Methods: All consenting cases of tinea presenting to outpatient department of dermatology department of Civil Service Hospital from March to August 2020 for a total of 6 months were included in this study. Tinea infection involving only the palms, soles, nails or scalp were excluded.Results: A total of 200 patients were included in this study. Among these, 175 patients (87.5%) were using topical corticosteroids. A significant association was noted between dermatophyte infection of more than one month and topical corticosteroids use (p<0.05). This study revealed that males were using super-potent topical corticosteroids more as compared to females (p<0.05). Moreover, no association was noted between the level of education attained and the use of topical corticosteroids (p=0.91). Only 25 (12%) patients were either using correct or no topical medications during the time of consultation with the dermatologist. Among the patients using topical corticosteroids, 155 (88.6%) patients were using them on recommendation of the local pharmacist and only 2 (1.2%) patients were prescribed by a physician. Conclusions: In short, use of topical steroids was rampant among patients with tinea whilst 77.5% patients procured steroid topicals over-the-counter. Hence, a tougher law and strict regulatory guidelines deemed necessary to curb the unauthorized and rampant sale of these medicines.Keywords: Dermatophytes; over-the-counter; steroid misuse; self-medications; tinea; topical corticosteroid

Download Full-text

TOPICAL STEROIDS ABUSE AND IT'S HIGH PREVALENCE WITH TEANIA INFECTIONS IN COVID-19 CRISIS TIME -A CLNICO EPIDEMIOLOGICAL STUDY

10.36106/paripex/1301262 ◽

2021 ◽

pp. 29-31

Author(s):

B Omprakash ◽

Jaya Krishna ◽

Kavitha Kavitha

Keyword(s):

South India ◽

Common Source ◽

Topical Steroids ◽

Inclusion Criteria ◽

Over The Counter ◽

Moderate Severity ◽

Detailed History ◽

Steroid Abuse ◽

High Prevalence ◽

History Of

Introduction: Topical corticosteroids are today among the most commonly prescribed medications indermatology clinics. Due to easy availability of steroid creams as over-the-counter drugs Steroid abuse has become a common problem .This study was conducted to see the magnitude of this problem of it and the clinical profile of these patients in our population in one part of south India. Material And Methods: All patients with a history of topical use of steroids on different skin problems mainly teania infected areas for a period greater than few months were enrolled in this study after taking an informed consent. A detailed history about the type of steroid used, duration of application, source of prescription of the drug (doctor/chemist/self/acquaintances) and indications were recorded. A detailed clinical examination of these patients was carried out and results were recorded. Results: This study was conducted over a period of 1 year and 380 patients who fulfilled the inclusion criteria were enrolled in this study. There were247 males and 133 female patients. The range of age of these patients varied from 5 years to 60 years.Teania cruris was the most common indication for steroid use.Severity of problem was got neglected mainly because of covid crisis time situation and other misguidance by ignorance,friends and Chemists.Chemists were the most common source of prescribing steroids.COVID economic crisis may be an another leading factor of using the easy avilable medicine at counter for mild to moderate severity of skin problems especially fungal tinea corporis/cruris. Atrophic changes of the skin were the most common adverse effects seen. Conclusion:Topical steroids are very commonly abused drugs.This problem is more common in youngsters,especially males.Over the counter availability of these drugs in our part of world is a major cause of their abuse

Download Full-text

Treatment of varicose tributaries with sclerotherapy with polidocanol 0.5 % foam

VASA ◽

10.1024/0301-1526/a000023 ◽

2010 ◽

Vol 39 (2) ◽

pp. 169-174 ◽

Cited By ~ 7

Author(s):

Reich-Schupke ◽

Weyer ◽

Altmeyer ◽

Stücker

Keyword(s):

Scientific Evidence ◽

Daily Practice ◽

Severe Adverse Effect ◽

Safe Procedure ◽

Efficacy And Safety ◽

Foam Sclerotherapy ◽

History Of ◽

One Year ◽

Additional Therapy

Background: Although foam sclerotherapy of varicose tributaries is common in daily practice, scientific evidence for the optimal sclerosant-concentration and session-frequency is still low. This study aimed to increase the knowledge on foam sclerotherapy of varicose tributaries and to evaluate the efficacy and safety of foam sclerotherapy with 0.5 % polidocanol in tributaries with 3-6 mm in diameter. Patients and methods: Analysis of 110 legs in 76 patients. Injections were given every second or third day. A maximum of 1 injection / leg and a volume of 2ml / injection were administered per session. Controls were performed approximately 6 months and 12 months after the start of therapy. Results: 110 legs (CEAP C2-C4) were followed up for a period of 14.2 ± 4.2 months. Reflux was eliminated after 3.4 ± 2.7 injections per leg. Insufficient tributaries were detected in 23.2 % after 6.2 ± 0.9 months and in 48.2 % after 14.2 ± 4.2 months, respectively. Only 30.9 % (34 / 110) of the legs required additional therapy. In 6.4 % vein surgery was performed, in 24.5 % similar sclerotherapy was repeated. Significantly fewer sclerotherapy-sessions were required compared to the initial treatment (mean: 2.3 ± 1.4, p = 0.0054). During the whole study period thrombophlebitis (8.2 %), hyperpigmentation (14.5 %), induration in the treated region (9.1 %), pain in the treated leg (7.3 %) and migraine (0.9 %) occurred. One patient with a history of thrombosis developed thrombosis of a muscle vein (0.9 %). After one year there were just hyperpigmentation (8.2 %) and induration (1.8 %) left. No severe adverse effect occurred. Conclusions: Foam sclerotherapy with injections of 0.5 % polidocanol every 2nd or 3rd day, is a safe procedure for varicose tributaries. The evaluation of efficacy is difficult, as it can hardly be said whether the detected tributaries in the controls are recurrent veins or have recently developed in the follow-up period. The low number of retreated legs indicates a high efficacy and satisfaction of the patients.

Download Full-text

Newton and the Origin of Civilization

10.23943/princeton/9780691154787.001.0001 ◽

2012 ◽

Cited By ~ 1

Author(s):

Jed Z. Buchwald ◽

Mordechai Feingold

Keyword(s):

Good Reason ◽

History Of Mathematics ◽

Primary Sources ◽

Ancient History ◽

Isaac Newton ◽

History Of ◽

Ancient Civilizations ◽

And Mathematics ◽

One Year ◽

Radical Ideas

Isaac Newton’s Chronology of Ancient Kingdoms Amended, published in 1728, one year after the great man’s death, unleashed a storm of controversy. And for good reason. The book presents a drastically revised timeline for ancient civilizations, contracting Greek history by five hundred years and Egypt’s by a millennium. This book tells the story of how one of the most celebrated figures in the history of mathematics, optics, and mechanics came to apply his unique ways of thinking to problems of history, theology, and mythology, and of how his radical ideas produced an uproar that reverberated in Europe’s learned circles throughout the eighteenth century and beyond. The book reveals the manner in which Newton strove for nearly half a century to rectify universal history by reading ancient texts through the lens of astronomy, and to create a tight theoretical system for interpreting the evolution of civilization on the basis of population dynamics. It was during Newton’s earliest years at Cambridge that he developed the core of his singular method for generating and working with trustworthy knowledge, which he applied to his study of the past with the same rigor he brought to his work in physics and mathematics. Drawing extensively on Newton’s unpublished papers and a host of other primary sources, the book reconciles Isaac Newton the rational scientist with Newton the natural philosopher, alchemist, theologian, and chronologist of ancient history.

Download Full-text

High Risk of One-year Stroke Recurrence in Patients with Younger Age and Prior History of Ischemic Stroke

Current Neurovascular Research ◽

10.2174/1567202616666190618164528 ◽

2019 ◽

Vol 16 (3) ◽

pp. 250-257 ◽

Cited By ~ 1

Author(s):

Jiann-Der Lee ◽

Ya-Han Hu ◽

Meng Lee ◽

Yen-Chu Huang ◽

Ya-Wen Kuo ◽

...

Keyword(s):

Logistic Regression ◽

Ischemic Stroke ◽

Multivariate Logistic Regression Analysis ◽

Stroke Recurrence ◽

Prior History ◽

Multivariate Logistic Regression ◽

Cart Analysis ◽

Younger Age ◽

History Of ◽

One Year

Background and Purpose: Recurrent ischemic strokes increase the risk of disability and mortality. The role of conventional risk factors in recurrent strokes may change due to increased awareness of prevention strategies. The aim of this study was to explore the potential risk factors besides conventional ones which may help to affect the advances in future preventive concepts associated with one-year stroke recurrence (OSR). Methods: We analyzed 6,632 adult patients with ischemic stroke. Differences in clinical characteristics between patients with and without OSR were analyzed using multivariate logistic regression and classification and regression tree (CART) analyses. Results: Among the study population, 525 patients (7.9%) had OSR. Multivariate logistic regression analysis revealed that male sex (OR 1.243, 95% CI 1.025 – 1.506), age (OR 1.015, 95% CI 1.007 - 1.023), and a prior history of ischemic stroke (OR 1.331, 95% CI 1.096 – 1.615) were major factors associated with OSR. CART analysis further identified age and a prior history of ischemic stroke were important factors for OSR when classified the patients into three subgroups (with risks of OSR of 8.8%, 3.8%, and 12.5% for patients aged > 57.5 years, ≤ 57.5 years/with no prior history of ischemic stroke, and ≤ 57.5 years/with a prior history of ischemic stroke, respectively). Conclusions: Male sex, age, and a prior history of ischemic stroke could increase the risk of OSR by multivariate logistic regression analysis, and CART analysis further demonstrated that patients with a younger age (≤ 57.5 years) and a prior history of ischemic stroke had the highest risk of OSR.

Download Full-text