S L Weber1. 1. Department of Medicine, Division of Endocrinology, University of Miami, Miami, Florida, USA.
Abstract
OBJECTIVE: To emphasize the potentially devastating consequences of topical application of corticosteroids. METHODS: A case report is presented of a previously healthy 38-year-old woman in whom florid Cushing's syndrome developed after prolonged use of Lotrisone. RESULTS: Four years of continuous topical administration of Lotrisone, a combination antifungal-corticosteroid product, led to the development of Cushing's syndrome. The cream had been applied to less than 10% of the total body surface area without use of occlusive dressings, and the patient had no evidence of liver dysfunction or systemic skin disorder. Laboratory studies revealed an unmeasurable corticotropin level, suppressed or unmeasurable cortisol levels, and suppressed or low-normal 24-hour urine collection values for 17-hydroxy-steroids, 17-ketosteroids, and urinary free cortisol, all of which confirm suppression of the hypothalamic-pituitary-adrenal axis. CONCLUSION: (1) Betamethasone dipropionate can lead to the development of Cushing's syndrome, even in the absence of enhancing factors. (2) Combination medications can lead to the unintentional use of component agents. (3) Availability of potent corticosteroids as over-the-counter medications allows for inappropriate duration of therapy and inadequate medical supervision.
OBJECTIVE: To emphasize the potentially devastating consequences of topical application of corticosteroids. METHODS: A case report is presented of a previously healthy 38-year-old woman in whom florid Cushing's syndrome developed after prolonged use of Lotrisone. RESULTS: Four years of continuous topical administration of Lotrisone, a combination antifungal-corticosteroid product, led to the development of Cushing's syndrome. The cream had been applied to less than 10% of the total body surface area without use of occlusive dressings, and the patient had no evidence of liver dysfunction or systemic skin disorder. Laboratory studies revealed an unmeasurable corticotropin level, suppressed or unmeasurable cortisol levels, and suppressed or low-normal 24-hour urine collection values for 17-hydroxy-steroids, 17-ketosteroids, and urinary free cortisol, all of which confirm suppression of the hypothalamic-pituitary-adrenal axis. CONCLUSION: (1) Betamethasone dipropionate can lead to the development of Cushing's syndrome, even in the absence of enhancing factors. (2) Combination medications can lead to the unintentional use of component agents. (3) Availability of potent corticosteroids as over-the-counter medications allows for inappropriate duration of therapy and inadequate medical supervision.
Authors: Marjan Alidoost; Gabriella A Conte; Khushboo Agarwal; Michael P Carson; Danielle Lann; Diane Marchesani Journal: Int Med Case Rep J Date: 2020-06-09