Use of corticosteroid cream causes Cushing’s syndrome in boy, 5: Case
Study highlights need for 'proper use and monitoring' of such medications
A 5-year-old boy with an inflammatory skin condition developed Cushing’s syndrome following a year of his parents’ use of a topical corticosteroid cream to treat his psoriasis, according to a new case study.
The researchers noted that this case “underlines the potential side effects of high-potency corticosteroids.”
Although the use of the cream was discontinued, and the child was given a tailored treatment regimen that included the use of hydrocortisone — commonly used as a hormone replacement therapy for people without enough cortisol — and medications for high blood pressure, his condition worsened. The youngster also developed other complications.
Overall, this case study emphasizes the need for “proper use and monitoring of topical corticosteroids … especially among children,” the researchers wrote, adding that it also demonstrates “the importance of physicians’ and parents’ awareness, highlighting the avoidance of excessive topical corticosteroid prescriptions.”
The case study, “Complicated iatrogenic Cushing’s syndrome induced by topical clobetasol propionate in a child with psoriasis: a case report and review of the literature,” was published in the Journal of Medical Case Reports.
Use of corticosteroid cream was without physician supervision
Cushing’s syndrome encompasses a range of conditions caused by abnormally high levels of cortisol, a steroid hormone essential for regulating metabolism, immune function, and other bodily processes. Elevated cortisol levels in individuals with Cushing’s syndrome can result in various symptoms, including significant weight gain, changes in skin appearance, muscle weakness, and severe fatigue.
Prolonged exposure to high doses of corticosteroid medications is a leading cause of iatrogenic, or medication-induced, Cushing’s syndrome. Corticosteroids are a group of medications that mimic the effects of cortisol, and are commonly used to reduce inflammation.
“Long-term use of oral or parenteral corticosteroids is the most common cause of … iatrogenic Cushing’s syndrome …, but [iatrogenic Cushing’s] occurs rarely following the administration of [topical corticosteroids],” the researchers wrote.
Here, the team detailed the case of a young boy in Iran who developed iatrogenic Cushing’s after the misuse of a cream containing a potent corticosteroid.
The boy had a medical history of plaque-form psoriasis since the age of 6 months.
By age 4, the child was admitted to the hospital showing several hallmark features of Cushing’s. These included excessive fat buildup around the waist — called central obesity — and behind the neck, known as a buffalo hump. The boy also experienced swelling in the face, known as a moon face, and had red streaks across the skin of the abdomen and extremities. A physical examination also revealed the presence of skin lesions caused by psoriasis.
In the year before the boy’s hospital admission, a physician had prescribed a cream containing a corticosteroid (clobetasol propionate) to treat his psoriasis skin lesions. While the recommendation was to follow up with the physician, the parents failed to do so as the lesions partly disappeared.
However, once his skin lesions reappeared, the topical cream was again reapplied arbitrarily, without physician supervision, the researchers noted. According to the mother, she applied the cream all over the boy’s body every day, for one year.
Boy’s condition worsened despite stopping use of cream
The cream was discontinued during the boy’s first hospitalization and a pediatric dermatologist prescribed oral methotrexate, an immunosuppressant, along with a topical lotion to treat the skin lesions.
Blood work also revealed the child had unusually low cortisol levels, for which he was given daily treatment with oral hydrocortisone. He also started treatment with enalapril (sold as Vasotec and others) to manage his high blood pressure.
Treatment led to a resolution of his skin lesions, so the boy was discharged home with a tailored treatment regimen and recommendations for weekly monitoring of blood pressure and follow-up.
Two weeks later, however, he was readmitted to the hospital following a surge of new skin lesions. In the week prior to the second hospitalization, he had experienced fever, vomiting, and diarrhea. Physical examination and lab tests confirmed his condition had worsened.
Parents should be warned and educated regarding [topical corticosteroids] side effects and the necessity of using [topical corticosteroids] in the appropriate quantity and treatment duration.
The child received treatment with methotrexate, which was administered via an intramuscular injection, along with intravenous, or into-the-vein, hydrocortisone and enalapril.
After spending a month in the hospital and against medical advice, the parents decided to take the boy home. He eventually died, the team noted.
“Regulating the safe dose of [topical corticosteroids] in pediatric patients can be challenging,” the researchers wrote. “Physicians should avoid excessive [topical corticosteroids] prescriptions, especially highly potent [topical corticosteroids] for children, and seek alternatives or combination therapy whenever possible.”
The researchers also noted the importance of patients and their caregivers following medication dosage instructions — especially for pediatric patients.
“Parents should be warned and educated regarding [topical corticosteroids] side effects and the necessity of using [topical corticosteroids] in the appropriate quantity and treatment duration,” the researchers concluded.
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