Coureau Bénédicte, Bussières Jean-François, Tremblay Stéphanie
Pharmacy Department, Centre Hospitalier de Martigues, Martigues, France.
Ann Pharmacother. 2008 Dec;42(12):1903-7. doi: 10.1345/aph.1L067. Epub 2008 Nov 18.
To report a case of Cushing's syndrome caused by continuous use of moderate- to high-potency topical corticosteroids over several months.
An 11-month-old patient with atopic dermatitis received uninterrupted treatment with moderate- to high-potency topical corticosteroids. He presented with several food allergies and was admitted to the hospital after atopic dermatitis worsened. Signs of growth retardation, which had begun at 6 months of age, were also noted during the child's hospital stay. An endocrinologist concluded that a lower-than-normal bone density scan and growth retardation on both weight and growth curves were due to suppression of the hypothalamicpituitary-adrenal (HPA) axis and a multifactorial failure to thrive.
This is a case of an infant overexposed to topical corticosteroid treatment who developed Cushing's syndrome within a few months. Local treatment of atopic dermatitis is classically based on the use of topical corticosteroids in combination with an emollient or other drugs. To limit local and general damaging effects, the choice of topical corticosteroid must be made in terms of patient age, severity and site of the rash, and the extent of skin involvement. Several factors influence the systemic absorption of topical corticosteroids. While our literature review indicated the possibility of a multifactorial origin of the child's growth retardation, the use of topical corticosteroids was shown to have contributed to suppression of the HPA axis. Application of the Naranjo probability scale indicated a probable relationship between the continuous and sustained administration of topical corticosteroids over several months and suppression of the HPA axis. Although topical corticosteroids are widely used and can be perceived by parents and patients to be safe, daily documentation of agents used and body surfaces exposed should be done during long-term treatment.
Continuous use of moderate- to high-potency topical corticosteroids over several months can contribute to Cushing's syndrome. Growth and development as well as cortisol levels should be monitored in children on long-term topical corticosteroid treatment.
报告一例因连续数月使用中效至强效外用糖皮质激素引起的库欣综合征病例。
一名11个月大的特应性皮炎患者接受了不间断的中效至强效外用糖皮质激素治疗。他患有多种食物过敏，在特应性皮炎恶化后入院。在患儿住院期间，还发现了自6个月大时就开始出现的生长发育迟缓迹象。一名内分泌学家得出结论，骨密度扫描低于正常水平以及体重和生长曲线的生长发育迟缓是由于下丘脑 - 垂体 - 肾上腺（HPA）轴受抑制以及多因素导致的发育不良。
这是一例外用糖皮质激素治疗过度暴露的婴儿，在几个月内就患上了库欣综合征。特应性皮炎的局部治疗通常基于外用糖皮质激素与润肤剂或其他药物联合使用。为了限制局部和全身的损害作用，必须根据患者年龄、皮疹的严重程度和部位以及皮肤受累范围来选择外用糖皮质激素。有几个因素会影响外用糖皮质激素的全身吸收。虽然我们的文献综述表明患儿生长发育迟缓可能有多种因素，但外用糖皮质激素的使用被证明导致了HPA轴的抑制。应用纳兰霍概率量表表明，连续数月持续使用外用糖皮质激素与HPA轴抑制之间可能存在关联。尽管外用糖皮质激素被广泛使用，且家长和患者可能认为其安全，但在长期治疗期间应每日记录所使用的药物和暴露的身体部位。
连续数月使用中效至强效外用糖皮质激素可导致库欣综合征。长期接受外用糖皮质激素治疗的儿童应监测其生长发育以及皮质醇水平。
