Síndrome de Cushing secundario a administración tópica decorticoesteroides / Cushing Syndrome due to topical corticosteroid misuse

Los corticoesteroides tópicos son drogas muy comunes, frecuentemente utilizadas en patologías dermatológicas. Su mal uso puede causar efectos sistémicos, como el síndrome de Cushing y la supresión del eje hipotalámico ­ hipofisiario ­ adrenal. Presentamos un caso de un lactante menor de siete meses quien desarrolla un síndrome de Cushing secundario al uso de Clobetasol por una dermatitis en el área del pañal, por tiempo prolongado, sin prescripción médica. Al examen físico se evidencia obesidad a predominio central, con fascie de luna llena, hipertricosis en región frontal, telangiectasias aisladas en mejillas y cuello de búfalo. Los paraclínicos demuestran una hipercolesterolemia, hipertrigliceridemia, elevación de las transaminasas y cortisol sérico en la mañana disminuido. Se concluye que se debe informar a los padres de los efectos adversos sistémicos de los esteroides tópicos y se sugiere evitar en pacientes pediátrico(AU)

Topical corticosteroids are very common drugs used in the treatment of inflammatory skin diseases. Prolonged ormisuse of them may cause systemic adverse effects, including Cushing syndrome and hypothalamic-pituitary-adrenal axissuppression. We present a case of a seven months old maleinfant who developed iatrogenic Cushing syndrome after diaperdermatitis treatment through misuse of Clobetasol, withoutdoctor's prescription. We observe redness and a moon face, abuffalo hump, central obesity and hirsutism. Laboratory values revealed hypercholesterolemia, hypertriglyceridemia, elevationin liver enzymes and low early morning cortisol. To conclude,parents must be informed by physicians about the adverse effect of steroids and the should be avoided in very young infant(AU)

Effect of topical corticosteroids on nasal patency after acute positive airway pressure exposure / Efeito dos corticosteroides tópicos na patência nasal após exposição aguda à pressão positiva nas vias aéreas

Abstract Introduction Nasal congestion and obstruction are reported in the majority of continuous positive airway pressure users and are frequently cited as reasons for noncompliance. Baseline inflammation due to allergic rhinitis could increase or exacerbate the inflammatory effect of high airflow in the nasal cavity as the result of continuous positive airway pressure and lead to greater continuous positive airway pressure intolerance. In this setting, intranasal steroids would be expected to counteract the nasal inflammation caused by allergic rhinitis and/or continuous positive airway pressure. Objective The aim of the present study is to evaluate the effects of topical corticosteroid use on nasal patency after acute exposure to positive pressure. Methods Ten individuals with allergic rhinitis were exposed to 1 h of continuous airway pressure (15 cm H2O) in the nasal cavity, delivered by a continuous positive airway pressure device. Visual analog scale, nasal obstruction symptom evaluation scale, acoustic rhinometry and peak nasal inspiratory flow were performed before and after the intervention. After 4 weeks topical nasal steroid (budesonide) application, positive pressure exposure was repeated as well as the first assessments. Results Patients reported a statistically significant improvement both on the visual analog (p = 0.013) and obstruction symptom evaluation scales (p < 0.01). Furthermore, objective measurements were improved as well, with increased nasal cavity volume on acoustic rhinometry (p = 0.02) and increased peak nasal inspiratory flow (p = 0.012), after corticosteroid treatment. Conclusion In patients with allergic rhinitis, intranasal corticosteroid therapy improved objective and subjective parameters of nasal patency after acute exposure of the nasal cavity to positive pressure.

Resumo Introdução Congestão e obstrução nasais são relatadas na maioria dos usuários de pressão positiva contínua nas vias aéreas e são frequentemente mencionadas como razões para a falta de aderência. A inflamação basal devida à rinite alérgica pode aumentar ou agravar o efeito inflamatório do alto fluxo de ar na cavidade nasal como resultado da pressão positiva contínua nas vias aéreas e aumentar a intolerância à mesma. Nesse cenário, espera-se que os esteróides intranasais neutralizem a inflamação nasal causada pela rinite alérgica e/ou pela pressão positiva contínua nas vias aéreas. Objetivo Avaliar os efeitos do uso tópico de corticosteroides na patência nasal após exposição aguda à pressão positiva. Métodos Dez indivíduos com rinite alérgica foram expostos a uma hora de pressão contínua nas vias aéreas (15 cm H2O) na cavidade nasal, fornecida por um dispositivo de pressão positiva contínua nas vias aéreas. A escala visual analógica, a escala Nasal Obstruction Symptom Evaluation, rinometria acústica e pico de fluxo inspiratório nasal foram aplicados antes e após a intervenção. Após 4 semanas de aplicação tópica de esteroide nasal (budesonida), a exposição positiva à pressão foi repetida, bem como as primeiras avaliações. Resultados Os pacientes relataram uma melhoria estatisticamente significante tanto na escala visual analógica (p = 0,013) quanto na escala Nasal Obstruction Symptom Evaluation (p < 0,01). Além disso, as medidas objetivas também foram melhoradas, com aumento do volume da cavidade nasal na rinometria acústica (p = 0,02) e aumento do pico de fluxo inspiratório nasal (p = 0,012), após o tratamento com corticosteroide. Conclusão Em pacientes com rinite alérgica, a terapia com corticosteroide intranasal melhorou os parâmetros objetivos e subjetivos da patência nasal após exposição aguda da cavidade nasal à pressão positiva.

Crusted (Norwegian) scabies in an infant: A case report

@#INTRODUCTION: Norwegian or crusted scabies is a rare and highly contagious form of skin parasitosis caused by Sarcoptes scabiei var. hominis. Individuals maffffinly affected are considered to be immunocompromised such as those on prolonged glucocorticosteroid therapy, with AIDS or organ transplant patients. This disease presents as a hyperkeratotic dermatosis with an acral distribution. CASE REPORT: This is a case of a 2-month-old healthy Filipino male, who was previously managed as a case of miliaria rubra and treated with clobetasol 0.05% – ketoconazole 2% cream for 1 week. The papules and plaques became widespread. Consult with a pediatrician revealed widespread scabies and for which patient was prescribed topical permethrin with no improvement. On examination, patient presented with multiple erythematous papules and plaques with crusts on the face, trunk, extremities, palms and soles. Thickened yellowish plaques were observed on the palms and soles. Both parents also presented with widespread papules most prominent on the flexural areas accompanied by nocturnal pruritus. On dermoscopy, numerous mites and burrows were seen in a “jet with contrail pattern.” Prominent yellowish scales were also noted. Patient was admitted due to fever and superimposed bacterial infection and was given IV oxacillin, paracetamol, 8% precipitated sulfur in a hypoallergenic lotion applied twice daily and sodium fusidate ointment. On the 4th hospital day, the patient was afebrile and the lesions were noted to decrease in both erythema and crusting. Follow-up dermoscopy revealed absence scales, burrows and mites. CONCLUSION: Prolonged, unsupervised use of topical corticosteroids in our case most likely induced an immunocompromised state thus predisposing the patient to develop Norwegian scabies. In countries were cases of Norwegian scabies have been unresponsive to permethrin and when ivermectin is not available, the use of precipitated sulfur may still be the best therapeutic and safest option for infants.

Misuse of topical corticosteroids in women in Hail region Saudi Arabia

Background: A lot of women seek to get beautified. Consequently, some of the women often resort to using the products contained corticosteroids (CS) and other kinds of cosmetics, and this significantly increased with year 2018, due to the influence of social media. Despite the benefits, that excessive use of corticosteroids leads to serious side effects.Methods: 769 electronic questionnaires were completed by women for using corticosteroids in Hail, Saudi Arabia. Statistical comparison was done using SPSS (ANOVA test) was used to compare the answers given by the participants and P values less than 0.05 were considered significant.Results: 769 women responded. More than 30.3% of the patients were in the age group 31 to 40 years. The main reason for using the topical corticosteroids was to lighten skin color and reduce wrinkles.Conclusions: Misuse of topical corticosteroids is widely spread among women in Hail city, and this due to various reasons, the most important of which is to get bleaching and get rid of skin blemishes.

Abuse of Topical Corticosteroids and its Consequences: A Prospective Study

Background: Misuse of topical corticosteroids is a widespread among young people in India, especially women. The inadvertent use of topical corticosteroids for various common dermatological conditions is associated with significant adverse effects Aim: To assess the steroid abuse for various common dermatological conditions and its adverse effects. Materials & Methods: Sixty patients who attended OPD dermatology were taken in to study. A detailed clinical history with regard to age, gender, education status, duration and frequency of use of topical steroids, type and formulation of the drug (lotion, cream, ointment), cause for using the drug and the source of the drug (by dermatologist, doctor- physician/Ayurvedic/homeopathic, over the counter (OTC) were taken. Results: Majority of patients were between the age group of 15-30 years and females were in predominance. The common indications were facial pigmentation, dermatophytosis and acne. The source of drug were mostly from pharmacist, friends and family members. Most commonly used steroid were betamethasone valerate, clobetasol propionate and mometasone furoate. The common side effects observed were acneiform eruptions, tinea incognito, and erythema with telangiectasia, cutaneous atrophy and striae. Conclusion: Topical steroids should be used cautiously and judiciously. Awareness should be given regarding the indications and its consequences. Avoidance of self-medication by over the counter purchase should be stressed upon. While treating children extreme care should be given regarding the selection of potency of topical steroids.

A fatal case of Staphylococcal Scalded skin syndrome associated with Iatrogenic Cushing syndrome due to potent topical steroid application in a 3-month-old female: A case report

Introduction@#Cushing syndrome caused by application of topical corticosteroids is rarely reported. Systemic side effects like suppression of hypothalamic-pituitary-adrenal axis, growth retardation in children and iatrogenic Cushing syndrome can occur even in small doses of potent topical steroids.1@*Case Summary@#This is a case of a 3-month old female who was referred to our department due to generalized erythema with desquamation. History revealed that the patient had recurrent eczema and the mother applied an over-the-counter medication containing Ketoconazole+Clobetasol 10mg/500mcg per 7-gram cream thrice daily for ten weeks. The estimated topical steroid applied weekly was around 8.5 grams and at time of admission, the patient had been exposed to approximately 50 grams of a potent topical corticosteroid. The patient presented with fever, irritability, and had positive Nikolsky sign thus managed as a case of staphylococcal scalded skin syndrome associated with topical steroid – induced iatrogenic Cushing syndrome. Unfortunately, patient’s condition worsened and with progressive pneumonia, she expired on the 23rd hospital day. The fatal outcome was due to SSSS which was complicated by progressive pneumonia and topical steroid – induced iatrogenic Cushing syndrome. The complex interplay of these features eventually led to sepsis and death.@*Conclusion@#This case highlights the risks related to abuse of potent steroid-containing preparations and the importance of education to prevent severe and catastrophic outcomes of injudicious steroid use.

Topical Corticosteroid Phobia among Parents of Children with Atopic Eczema in Korea

BACKGROUND: Topical corticosteroids (TCS) are the first-line agents for the treatment of atopic dermatitis (AD). However, a vague phobia concerning the use of TCS exists among parents of children with AD because of misinformation, and studies on the subject are insufficient. OBJECTIVE: To assess the current state of steroid phobia among parents of atopic children in Korea and to investigate the importance of education in its reduction. METHODS: By using a structured questionnaire, 126 parents of children with AD (22.2% fathers, 77.8% mothers) were interviewed. After the questionnaire administration, all participants were educated about TCS use. RESULTS: Overall, 67.5% of the parents showed steroid phobia. A statistical correlation was found between steroid phobia and knowledge of potential adverse events, experience of TCS use, and adherence to treatment (p<0.05). Adherence to treatment tended to be lower among parents with steroid phobia. The most recognized adverse effects of TCS were skin atrophy and thinning (71.9%). The most prevalent information source leading to steroid phobia was the Internet (49.2%). The risk factors for steroid phobia were AD severity (odds ratio [OR]=5.332 [moderate], 9.040 [severe] vs. mild; p=0.001) and the knowledge of potential adverse events (OR=2.658; p=0.021). CONCLUSION: We found a high prevalence of steroid phobia among parents of patients with AD, and here show the impact of this phobia on treatment adherence. We emphasize the important role of dermatologists as providers of accurate information and appropriate education about the use of TCS.

Topical corticosteroid-induced rosacea-like dermatitis: A clinical study of 110 cases.

Background: Prolonged and continuous use of topical steroids leads to rosacea-like dermatitis with variable clinical presentations. Aims: To study the various clinical presentations of patients with topical corticosteroid-induced rosacea-like dermatitis (TCIRD), who had a history of prolonged and repeated use of topical steroids for reasons other than the known disease entities. Methods: A total of 110 patients were enrolled for the study over a period of 2 years, excluding all those with the known disease entity in which topical steroids were commonly used. Detailed history which also included the source and the type of topical steroid use was taken along with clinical examination. Results: There were 12 males and 98 females with their age ranging from 18 to 54 years. The duration of topical steroid use ranged from 4 months to 20 years. The most common clinical presentation was diffuse erythema of the face. Most of the patients had rebound phenomenon on discontinuation of the steroid. The most common topical steroid used was Betamethasone valerate, which could be due to its easy availability and low cost. Conclusion: Varied clinical presentations are seen with prolonged and continuous use of topical steroids. The treatment of this dermatitis is difficult, requiring complete cessation of the offending steroid, usually done in a tapering fashion.

Clinical efficacy of benadryl cream and metronidazle cream in treatment of topical corticosteroid dependent dermatitis / 中华医学美学美容杂志

Objective To assess the clinical efficacy and safety of 1% benadryl and 3 % metronidazle cream in the treatment of topical corticosteroid dependent dermatitis. Methods The study was conducted in a single-blind way. The 86 patients were divided into 3 groups: 1% benadryl and 3 %metronidazle cream (group A), loratadine (group B) and gluco-corticoids (group C). All preparations were applied twice daily for 8 weeks. Study visits took place at baseline and weeks 2, 4 and 8. Results The clinical response rate in the groups A, B and C was 86.20%, 73.33%, and 66.67%, respectively; the clinical response rate in group A was significantly higher than that in groups B and C (P<0.05). Conclusions 1% benadryl and 3 % metronidazle cream are effective and safe in the treatment of topical torticosteroid dependent dermatitis.

Bilateral Peripheral Infiltrative Keratitis After LASIK

PURPOSE: To present a case of peripheral infiltrative keratitis mimicking infectious keratitis on the flap margin and limbus, which appeared on the first postoperative day after the laser in situ keratomileusis (LASIK). METHODS: A 36-year-old woman who underwent uneventful bilateral simultaneous LASIK developed multiple round infiltrate along the flap margin reaching to limbus from the 11 o'clock to 6 o'clock area in both eyes. RESULTS: The flap was lifted and irrigation was performed with antibiotics. but infiltration seemed to appear again. The infiltrate was more concentrated at the periphery and was extended to the limbus. Direct smear and culture for bacteria and fungus were negative. Topical prednisolone acetate 1% eye drops was added, infiltrative condition was resolved. CONCLUSIONS: LASIK induced peripheral infiltrative keratitis, in which infectious origin was ruled out, is reported.

A Favre-Racouchot Syndrome Developed on the Applied area of Topical Corticosteroid / 대한피부과학회지

Favre-Racouchot syndrome, also known as nodular elastosis with cysts and comedones, typically presents with large black open comedones, furrows, and nodules in the periorbital region and over the malar eminence. The pathogenesis of Favre-Racouchot syndrome is still uncertain. However it has been postulated that damage from ultraviolet radiation, combined with some unknown host predisposition, leads to the degeneration of the supporting dermal connective tissue. We report a case of Favre-Racouchot syndrome that developed on the applied area of topical corticosteroid for a preceding post-herpetic neuralgia lesion. This case is unique to suggest that the catabolic effect of corticosteroid is superimposed on the UV-induced degeneration of dermal connective tissue as a pathogenic mechanism of Favre-Racouchot syndrome.

Effect of Topical Corticosteroid on Nasal Polyps / 대한이비인후과학회지

BACKGROUND: Topical nasal corticosteroid therapy produces clinical improvement in patients with nasal polyposis, but there are lots of controversy about the pathogenesis of nasal polyps and the mode of action of steroid therapy. OBJECTIVES: To examine the mechanism of steroid effect, we investigated the histological change in apex, body and stalk of nasal polyps individually after topical steroid therapy. MATERIALS AND METHODS: Ten patients with nasal polyposis were treated with budesonide nasal spray, 100ng(50ng/puff) twice daily in each nostril for 4 weeks. we quantified the number of inflammatory cell types and compared the histologic types and structures in each portion of nasal polyps from the patients. RESULTS: Administration of topical corticosteroid over 2 weeks caused changes in each portion of nasal polyps histologically. The histologic changes showed decreased edema and increased fibrosis under light microscope and it was evident with longer administration of the topical corticosteroid. The number of plasma cells in body portion was decreased after treatment. Electron microscopy showed that the number of degranulated granules of mast cell was increased in 2 weeks after treatment and then decreased in 4 weeks at pedicle portion of nasal polyps. CONCLUSION: The results of this study suggest that the administration of topical corticosteroid may cause activation of healing process histologically.