title: [Symptomatic adrenal insufficiency secondary to the use of cutaneous topical steroids for skin-bleaching].
abstract: In black population, the skin-bleaching with cutaneous topical corticosteroids on a large body area is a widespread practice and is associated with numerous cutaneous complications. We report a 25-year-old Congolese woman who was admitted for weakness, arthralgias and abdominal pain. The association of a relative hyperpigmentation of the small joints of hands and feet with clinical features of hypercorticism led to suspect a chronic use of cutaneous topical steroids for skin-bleaching. On biological tests, plasma cortisol and corticotropin levels were undetectable and the short corticotropin (ACTH) stimulation test was negative, leading to the diagnosis of adrenal insufficiency complicating the chronic use of topical steroids. Clinical symptoms resolved with hydrocortisone therapy. One year later, the patient admitted a five-year continuous use of cutaneous topical steroids (betamethasone, 0.05%). Skin-bleaching through chronic use of cutaneous topical steroids, is a common practice in black women, and should be suspected in the presence of adrenal insufficiency with or without clinical features of hypercorticism, and conversely, skin-bleaching users should be tested for hypothalamo-pituitary-adrenal function.
authors.affiliation: CNRS, service de médecine interne, hôpital Pitié-Salpêtrière, AP-HP, UMR 7087, université Pierre-et-Marie-Curie-Paris-6, 75013 Paris, France. damien.sene@psl.aphp.fr
authors.forename: D
authors.initials: D
authors.lastname: Sène
authors.forename: D L T
authors.initials: DL
authors.lastname: Huong-Boutin
authors.forename: M
authors.initials: M
authors.lastname: Thiollet
authors.forename: S
authors.initials: S
authors.lastname: Barete
authors.forename: P
authors.initials: P
authors.lastname: Cacoub
authors.forename: J-C
authors.initials: JC
authors.lastname: Piette
mesh_terms: D000309:Adrenal Insufficiency / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001623:Betamethasone / Q000008:administration & dosage / Q000009:adverse effects*; D003358:Cosmetics / Q000009:adverse effects*; D003879:Dermatologic Agents / Q000009:adverse effects*; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use; D012880:Skin Pigmentation / Q000187:drug effects*; D013997:Time Factors
chemical_list: D000893:Anti-Inflammatory Agents; D003358:Cosmetics; D003879:Dermatologic Agents; D005938:Glucocorticoids; D001623:Betamethasone; D006854:Hydrocortisone