title: Adrenal insufficiency as a result of long-term misuse of topical corticosteroids.
abstract: The treatment of chronic inflammatory skin disease is associated with the use of topical corticosteroids. Their efficacy, tolerability and adverse effects depend on several factors, specifically potency, type of preparation, extemporaneous dilutions, quantity used, magnitude of the treated body surface, frequency of application, location, patient age, method of application and condition of the skin barrier. We report on two men suffering from chronic inflammatory skin disease, who presented with fatigue and cushingoid appearance after prolonged self-application of potent corticosteroids. Impairment of the skin barrier due to their underlying skin disease, frequent self-application of topical steroids and repeated application of the entire body led to extensive absorption of these substances, eventually culminating in the suppression of the pituitary-hypothalamic-adrenal axis. In conclusion, topical corticosteroids are effective and well-established therapeutic modalities. However, inappropriate use of topical corticosteroids can cause side effects.
authors.affiliation: Department of Dermatology, Innsbruck Medical University, Innsbruck, Austria.
authors.forename: Barbara C
authors.initials: BC
authors.lastname: Böckle
authors.forename: David
authors.initials: D
authors.lastname: Jara
authors.forename: Werner
authors.initials: W
authors.lastname: Nindl
authors.forename: Werner
authors.initials: W
authors.lastname: Aberer
authors.forename: Norbert T
authors.initials: NT
authors.lastname: Sepp
mesh_terms: D000279:Administration, Cutaneous; D000309:Adrenal Insufficiency / Q000139:chemically induced*; D000328:Adult; D001623:Betamethasone / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D002908:Chronic Disease; D003480:Cushing Syndrome / Q000139:chemically induced*; D003876:Dermatitis, Atopic / Q000188:drug therapy; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D008297:Male; D011565:Psoriasis / Q000188:drug therapy; D012651:Self Medication / Q000009:adverse effects*; D013997:Time Factors; D055815:Young Adult
chemical_list: D005938:Glucocorticoids; C011175:betamethasone-17,21-dipropionate; D001623:Betamethasone