MON-510 - Absorbed by the Skin: Iatrogenic Cushing Syndrome from Long-Term Topical Corticosteroids

Introduction

Prolonged use of corticosteroids on compromised skin leads to excessive systemic absorption, increasing the risk of iatrogenic Cushing's syndrome and hypothalamic-pituitary-adrenal (HPA) axis suppression. We report a case illustrating this complication in the context of chronic dermatoses.

Case Presentation

A 64-year-old woman with hypertension, dyslipidemia, and chronic intertriginous dermatitis arrived with severe diffuse erythema, bullae, and widespread desquamation consistent with staphylococcal scalded skin syndrome (SSSS). She reported using medium- to high-potency topical steroids, including betamethasone and triamcinolone, along with antifungal agents for about 7 years. On admission, she presented with hypotension (mean arterial pressure less than 65 mm Hg), hypoxia (SpO2 88%), acute kidney injury, and a markedly elevated C-reactive protein of 268 mg/L (Reference: 0-5). She was treated with intravenous antibiotics and methylprednisolone with subsequent improvement.

On physical examination, she shows facial plethora, dorsocervical fat pad, central obesity with a BMI of 50.4 kg/m², violaceous abdominal striae affecting the flanks, thighs, breasts, and arms, easy bruising, and lower extremity edema. Laboratory results reveal a low morning serum cortisol level of 2.8 μg/dL (Reference: 3.44-22.45), raising concerns for hypothalamic-pituitary-adrenal (HPA) axis suppression; adrenocorticotropic hormone (ACTH) levels are pending. Thyroid-stimulating hormone is within the normal range at 0.77 uIU/mL (Reference: 0.55-4.78). She was eventually moved to inpatient rehabilitation after clinical stabilization.

Discussion

This case highlights the importance of significant endocrine complications caused by prolonged topical corticosteroid use, especially when the skin barrier is disrupted. Classic Cushingoid features along with signs of adrenal suppression underscore the need to recognize topical steroids as a cause of iatrogenic Cushing syndrome. Increasing awareness is essential to prevent delayed diagnosis and avoid severe complications.

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