FİLİZ TÜTÜNCÜLER KÖKENLİ, Mustafa TEKİN, Demet BALCI, Özlem ŞAHALOĞLU

Iatrogenic cushing syndrome due to topical steroid administration in an infant

Topikal steroid tedavisi, kronik cilt lezyonlarında sıklıkla kullanılır. Sistemik kullanım ile kıyaslandığında yan etkileri daha az olmasına rağmen, süt çocuklarında ciltten emilimi daha fazla olduğu için, topikal steroid uygulanan bu çocuklar hipotalamus-hipofiz-böbrek üstü bezinin baskılanmasına bağlı adrenal yetersizlik veya Cushing sendromu gelişmesi açısından risk altındadırlar. Ancak süt çocuğunda topikal steroid uygulamasına bağlı Cushing sendromu ender görülür. Bu makalede diaper dermatiti nedeniyle uzun süreli klobetazol propiyonat tedavisine bağlı iyatrojenik Cushing sendromu gelişen bir olgu sunulmuştur.

Süt çocuğunda topikal steroid uygulamasına bağlı iyatrojenik cushing sendromu

Topical therapy with glucocorticoids is used commonly in chronic dermatoses. Although side effects are less common compared to systemic use, infants who are exposed to topical corticosteroids have greater risk for Cushing syndrome or adrenocortical insuffiency caused by suppression of hypothalamic-pituitary-adrenal axis because glucocorticoids are highly absorbed through the diaper area. However, the development of Cushing syndrome in an infant from topical steroid therapy is unusual. We present an infant with diaper dermatitis who developed iatrogenic Cushing syndrome due to prolonged clobetosel propionate use.

PDF

___

1) Kumar S, Singh RJ, Reed AM, Lteif AN. Cushing's syndrome after intra-articular and intradermal administration of triamcinolone acetonide in three pediatric patients. Pediatrics 2004;113:1820-4.
2) Feiwel M. Percutaneous absorption of topical steroids in children. Br J Dermatol 1969;81(Suppl 4):113-6.
3) 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;115:475-84.
4) 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.
5) Prawer SE, Katz HI. Guidelines for using superpotent topical steroids. Am Fam Physician 1990;41:1531-8.
6) Ermis B, Ors R, Tastekin A, Ozkan B. Cushing's syndrome secondary to topical corticosteroids abuse. Clin Endocrinol 2003;58:795-6.
7) Siklar Z, Bostanci I, Atli O, Dallar Y. An infantile Cushing syndrome due to misuse of topical steroid. Pediatr Dermatol 2004;21:561-3.
8) Ozon A, Cetinkaya S, Alikasifoglu A, Gonc EN, Sen Y, Kandemir N. Inappropriate use of potent topical glucocorticoids in infants. J Pediatr Endocrinol Metab 2007;20:219-25.
9) Güven A, Gülümser O, Ozgen T. Cushing's syndrome and adrenocortical insufficiency caused by topical steroids: misuse or abuse? J Pediatr Endocrinol Metab 2007;20:1173-82.
10) Abraham G, Gottschalk J, Ungemach FR. Evidence for ototopical glucocorticoid-induced decrease in hypothalamic-pituitary-adrenal axis response and liver function. Endocrinology 2005;146:3163-71.
11) Sherlock S, Dooley J, editors. Diseases of the liver and biliary system. Oxford: Blackwell Science; 2002.
12) Boumpas DT, Paliogianni F, Anastassiou ED, Balow JE. Glucocorticosteroid action on the immune system: molecular and cellular aspects. Clin Exp Rheumatol 1991;9:413-23.
13) Ohman EM, Rogers S, Meenan FO, McKenna TJ. Adrenal suppression following low-dose topical clobetasol propionate. J R Soc Med 1987;80:422-4.
14) Huizenga NA, Koper JW, De Lange P, Pols HA, Stolk RP, Burger H, et al. A polymorphism in the glucocorticoid receptor gene may be associated with and increased sensitivity to glucocorticoids in vivo. J Clin Endocrinol Metab 1998;83:144-51.