Cushing Syndrome due to Inappropriate Corticosteroid Topical Treatment of Undiagnosed Scabies

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.

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

Nepal Journal of Dermatology Venereology & Leprology ◽

10.3126/njdvl.v17i1.23291 ◽

2019 ◽

Vol 17 (1) ◽

pp. 73-75

Author(s):

Mohan Bhusal ◽

Eliz Aryal ◽

Sabina Bhattarai ◽

Sanju Babu Shrestha ◽

Alark Rajouria

Keyword(s):

Topical Corticosteroid ◽

Cushing Syndrome ◽

Topical Steroids ◽

Over The Counter ◽

Facial Hair ◽

Topical Corticosteroids ◽

Rare Phenomenon ◽

History Of ◽

One Year ◽

Buffalo Hump

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

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Acute Pustular Dermatosis, Following Topical Treatment With Pimecrolimus, in a Child Affected With Atopic and Contact Hand Dermatitis

The Journal of Pediatric Pharmacology and Therapeutics ◽

10.5863/1551-6776-21.1.81 ◽

2016 ◽

Vol 21 (1) ◽

pp. 81-84

Author(s):

Dimitri Poddighe ◽

Valeria Brazzelli ◽

Amelia Licari ◽

Gian Luigi Marseglia

Keyword(s):

Adverse Drug Reaction ◽

Atopic Dermatitis ◽

Drug Reaction ◽

Risk Factor ◽

Topical Treatment ◽

Leukocytoclastic Vasculitis ◽

Important Risk Factor ◽

Hand Dermatitis ◽

Clinical Indications

Atopic dermatitis is considered an important risk factor for chronic hand dermatitis, which can be seen in children too. Pimecrolimus cream 1% is approved to treat atopic dermatitis in children aged 2 years or older. In adults, this drug has been used for some clinical indications other than atopic dermatitis, such as chronic hand dermatitis. Here, we describe an adverse drug reaction in a 2-year-old child affected with atopic dermatitis, who was treated with topical pimecrolimus in order to ameliorate her concomitant hand dermatitis. The use of topical pimecrolimus led to a previously undescribed hand pustular dermatosis, being consistent with a form of pustular leukocytoclastic vasculitis, which required the permanent discontinuation of topical pimecrolimus.

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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.

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Infantile Iatrogenic Cushing Syndrome due to Topical Steroids

Case Reports in Pediatrics ◽

10.1155/2019/2652961 ◽

2019 ◽

Vol 2019 ◽

pp. 1-4

Author(s):

Lulwah Alkhuder ◽

Horia Mawlawi

Keyword(s):

Pituitary Adenoma ◽

Young Children ◽

Cushing Syndrome ◽

Topical Steroids ◽

Age Group ◽

Adrenal Hyperplasia ◽

Inappropriate Use ◽

Endogenous Release ◽

Free Plasma ◽

Parenteral Preparation

Cushing syndrome is an endocrinological disorder characterized by increased free plasma glucocorticoids level. It is either due to an excessive endogenous release of steroids (e.g., pituitary adenoma or adrenal hyperplasia) or exogenous administration of steroids. In children, iatrogenic Cushing syndrome is the most common form of Cushing syndrome occurring in this age group. The vast majority of cases are due to oral or parenteral preparation of steroids, which are commonly prescribed for pulmonary, hematological, renal, or autoimmune pathologies. Topical preparations can rarely cause Cushing syndrome in young children, and only a few cases were reported in the literature, where the patients were older than 5 months of age. In this report, we present a three-month-old girl who developed iatrogenic Cushing syndrome due to prolonged and inappropriate use of topical clobetasol cream for napkin dermatitis.

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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

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