The treatment of chronic inflammatory skin disease is associated with the use of topical corticosteroids. Their efficacy, tolerability and adverse effects depend on several factors, specifically potency, type of preparation, extemporaneous dilutions, quantity used, magnitude of the treated body surface, frequency of application, location, patient age, method of application and condition of the skin barrier. We report on two men suffering from chronic inflammatory skin disease, who presented with fatigue and cushingoid appearance after prolonged self-application of potent corticosteroids. Impairment of the skin barrier due to their underlying skin disease, frequent self-application of topical steroids and repeated application of the entire body led to extensive absorption of these substances, eventually culminating in the suppression of the pituitary-hypothalamic-adrenal axis. In conclusion, topical corticosteroids are effective and well-established therapeutic modalities. However, inappropriate use of topical corticosteroids can cause side effects.

1.
Spencer CM, Wagstaff AJ: Prednicarbate: a review of its pharmacological properties and therapeutic use in the treatment of dermatological disorders. BioDrugs 1998;9:61-86.
2.
Schafer-Korting M, Kleuser B, Ahmed M, Holtje HD, Korting HC: Glucocorticoids for human skin: new aspects of the mechanism of action. Skin Pharmacol Physiol 2005;18:103-114.
3.
Charman C, Williams H: The use of corticosteroids and corticosteroid phobia in atopic dermatitis. Clin Dermatol 2003;21:193-200.
4.
Brazzini B, Pimpinelli N: New and established topical corticosteroids in dermatology: clinical pharmacology and therapeutic use. Am J Clin Dermatol 2002;3:47-58.
5.
Hengge UR, Ruzicka T, Schwartz RA, Cork MJ: Adverse effects of topical glucocorticosteroids. J Am Acad Dermatol 2006;54:1-15; quiz 16-18.
6.
Turpeinen M: Influence of age and severity of dermatitis on the percutaneous absorption of hydrocortisone in children. Br J Dermatol 1988;118:517-522.
7.
Levin C, Maibach HI: Topical corticosteroid-induced adrenocortical insufficiency: clinical implications. Am J Clin Dermatol 2002;3:141-147.
8.
Grinspoon SK, Biller BM: Clinical review 62: Laboratory assessment of adrenal insufficiency. J Clin Endocrinol Metab 1994;79:923-931.
9.
Gilbertson EO, Spellman MC, Piacquadio DJ, Mulford MI: Super potent topical corticosteroid use associated with adrenal suppression: clinical considerations. J Am Acad Dermatol 1998;38:318-321.
10.
Tempark T, Phatarakijnirund V, Chatproedprai S, Watcharasindhu S, Supornsilchai V, Wananukul S: Exogenous Cushing's syndrome due to topical corticosteroid application: case report and review literature. Endocrine 2010;38:328-334.
11.
Feldman SR, Yentzer BA: Topical clobetasol propionate in the treatment of psoriasis: a review of newer formulations. Am J Clin Dermatol 2009;10:397-406.
12.
Turpeinen M, Salo OP, Leisti S: Effect of percutaneous absorption of hydrocortisone on adrenocortical responsiveness in infants with severe skin disease. Br J Dermatol 1986;115:475-484.
13.
Munro DD: The effect of percutaneously absorbed steroids on hypothalamic-pituitary-adrenal function after intensive use in in-patients. Br J Dermatol 1976;94(suppl 12):67- 76.
14.
Lebrun-Vignes B, Legrain V, Amoric J, Taïeb A: Comparative study of efficacy and effect on plasma cortisol levels of micronised desonide cream 0.1 p. 100 versus betamethasone dipropionate cream 0.05 p. 100 in the treatment of childhood atopic dermatitis. Ann Dermatol Venereol 2000;127:590-595.
15.
Kerner M, Ishay A, Ziv M, Rozenman D, Luboshitzky R: Evaluation of the pituitary-adrenal axis function in patients on topical steroid therapy. J Am Acad Dermatol 2011;65:215-216.
16.
Carruthers JA, August PJ, Staughton RC: Observations on the systemic effect of topical clobetasol propionate (Dermovate). Br Med J 1975;4:203-204.
17.
Ohman EM, Rogers S, Meenan FO, McKenna TJ: Adrenal suppression following low-dose topical clobetasol propionate. J R Soc Med 1987;80:422-424.
18.
Schoepe S, Schacke H, May E, Asadullah K: Glucocorticoid therapy-induced skin atrophy. Exp Dermatol 2006;15:406-420.
19.
Kecskés A, Jahn P, Matthes H, Kuhlmann RK, Lange L: Systemic effects of topically applied methylprednisolone aceponate in healthy volunteers. J Am Acad Dermatol 1993;28:789-792.
20.
Kecskés A, Heger-Mahn D, Kuhlmann RK, Lange L: Comparison of the local and systemic side effects of methylprednisolone aceponate and mometasone furoate applied as ointments with equal antiinflammatory activity. J Am Acad Dermatol 1993;29:576-580.
21.
Weston WL, Fennessey PV, Morelli J, Schwab H, Mooney J, Samson C, Huff L, Harrison LM, Gotlin R: Comparison of hypothalamus-pituitary-adrenal axis suppression from superpotent topical steroids by standard endocrine function testing and gas chromatographic mass spectrometry. J Invest Dermatol 1988;90:532-535.
22.
Walsh P, Aeling JL, Huff L, Weston WL: Hypothalamus-pituitary-adrenal axis suppression by superpotent topical steroids. J Am Acad Dermatol 1993;29:501-503.
23.
Allenby CF, Sparkes CG: Halogenation and topical corticosteroids: a comparison between the 17-butyrate esters of hydrocortisone and clobetasone in ointment bases. Br J Dermatol 1981;104:179-183.
24.
Allenby CF, Main RA, Marsden RA, Sparkes CG: Effect on adrenal function of topically applied clobetasol propionate (Dermovate). Br Med J 1975;4:619-621.
25.
Katz HI, Hien NT, Prawer SE, Mastbaum LI, Mooney JJ, Samson CR: Superpotent topical steroid treatment of psoriasis vulgaris - clinical efficacy and adrenal function. J Am Acad Dermatol 1987;16:804-811.
26.
Aubert-Wastiaux H, Moret L, Le Rhun A, Fontenoy AM, Nguyen JM, Leux C, Misery L, Young P, Chastaing M, Danou N, Lombrail P, Boralevi F, Lacour JP, Mazereeuw-Hautier J, Stalder JF, Barbarot S: Topical corticosteroid phobia in atopic dermatitis: a study of its nature, origins and frequency. Br J Dermatol 2011;165:808-814.
27.
Charman CR, Morris AD, Williams HC: Topical corticosteroid phobia in patients with atopic eczema. Br J Dermatol 2000;142:931-936.
28.
Hon KL, Leung TF, Yau HC, Chan T: Paradoxical use of oral and topical steroids in steroid-phobic patients resorting to traditional Chinese medicines. World J Pediatr 2012;8: 263-267.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.