Peng Xing, Quan Gen, She Xiao-Guang, Wu Jing-Jing, Ge Qin
Department of Dermatology, Jingmen Central Hospital, Jingmen Central Hospital Affiliated to Jingchu University of Technology, Jingmen, 448000, People's Republic of China.
Department of Dermatology, Wuhan Asia General Hospital, Wuhan Asia General Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, 430000, People's Republic of China.
Clin Cosmet Investig Dermatol. 2025 Sep 2;18:2127-2132. doi: 10.2147/CCID.S540407. eCollection 2025.
Topical glucocorticoids are widely used in psoriasis treatment but may lead to systemic adverse effects, particularly with prolonged use. While pediatric cases are well-documented, adult-onset iatrogenic Cushing's syndrome from topical corticosteroids remains under-recognized.
A 31-year-old woman with a 10-year history of psoriasis vulgaris self-administered high-potency clobetasol propionate ointment (monthly cumulative dose escalated from 30 g to 100 g over 22 months) under no physician supervision. She presented with erythrodermic psoriasis and Cushingoid features (moon facies, violaceous striae, pitting oedema). Laboratory tests confirmed suppressed cortisol (<1.5 nmol/L) and ACTH (2.86 pg/mL). Management included gradual withdrawal of topical steroids, initiation of oral methylprednisolone (8 mg daily) for HPA axis support, and transition to low-potency desonide. Four-month follow-up showed normalization of cortisol levels (167.1 nmol/L at 8:00 AM).
This case highlights the systemic risks of unsupervised, escalating use of high-potency topical corticosteroids in adults with impaired skin barrier. It underscores the need for adherence to dosing guidelines, patient education, and routine endocrine monitoring.
外用糖皮质激素广泛用于银屑病治疗，但可能导致全身不良反应，尤其是长期使用时。虽然儿科病例有充分记录，但外用糖皮质激素引起的成人迟发性医源性库欣综合征仍未得到充分认识。
一名31岁寻常型银屑病病史10年的女性，在没有医生监督的情况下自行使用强效丙酸氯倍他索软膏（22个月内每月累积剂量从30克增加到100克）。她出现了红皮病型银屑病和库欣样特征（满月脸、紫红色条纹、凹陷性水肿）。实验室检查证实皮质醇（<1.5 nmol/L）和促肾上腺皮质激素（2.86 pg/mL）受到抑制。治疗包括逐渐停用外用类固醇，开始口服甲泼尼龙（每日8毫克）以支持下丘脑-垂体-肾上腺轴，并过渡到低效的地奈德。四个月的随访显示皮质醇水平恢复正常（上午8点时为167.1 nmol/L）。
该病例突出了皮肤屏障受损的成年人在无监督情况下逐渐增加使用强效外用糖皮质激素的全身风险。它强调了遵守给药指南、患者教育和常规内分泌监测的必要性。
