title: Iatrogenic Cushing's syndrome in children presenting at Children's Hospital Lahore using nappy rash ointments.
abstract: OBJECTIVE
  To study the characteristics of infants and children presenting with iatrogenic Cushing's Syndrome due to nappy rash ointments.
  
  
  METHODS
  The descriptive study was conducted at the Children's Hospital, Lahore, from April to September 2013, and comprised patients presenting with cushingoid features and history of using nappy rash ointments. Patients having Cushing's Syndrome due to causes other than iatrogenic were excluded and so were those taking oral or parenteral steroids due to skin allergy, renal or respiratory disease. Demographic data, history and examination of all patients were recorded on a proforma and results were analysed using SPSS 16.
  
  
  RESULTS
  Of the total 18 patients, 13(72%) were girls and 5(27%) were boys. Eight (44.4%) patients were younger than 6 months, 6(33.3%) were between 6 months to 1 year, while 4(22.2%) were between 12 and 18 months of age. Clobetasol alone was the most frequently used agent responsible in 13(72%) cases. Duration of use of steroid ointment was as short as 3 weeks to as much as 1 year. All the patients were using disposable diapers. Ointment was prescribed by a doctor in 5(27%) cases and self-prescribed (relative or neighbour) in 13(72%).
  
  
  CONCLUSIONS
  Self-medication and prolonged use of potent steroid ointments are major contributors in development of iatrogenic Cushing's Syndrome in infants and children. Younger age, female gender and use of disposable diapers were other important predisposing factors.
authors.affiliation: Department of Paediatric Endocrinology, The Children's Hospital and the Institute of Child Health, Lahore, Pakistan.
authors.forename: Hina
authors.initials: H
authors.lastname: Sattar
authors.affiliation: Department of Paediatric Endocrinology, The Children's Hospital and the Institute of Child Health, Lahore, Pakistan.
authors.forename: Jaida
authors.initials: J
authors.lastname: Manzoor
authors.affiliation: Department of Paediatric Endocrinology, The Children's Hospital and the Institute of Child Health, Lahore, Pakistan.
authors.forename: Liaqat
authors.initials: L
authors.lastname: Mirza
authors.affiliation: Department of Paediatric Endocrinology, The Children's Hospital and the Institute of Child Health, Lahore, Pakistan.
authors.forename: Abdul Malik
authors.initials: AM
authors.lastname: Sheikh
authors.affiliation: Department of Paediatric Endocrinology, The Children's Hospital and the Institute of Child Health, Lahore, Pakistan.
authors.forename: Taeed Ahmad
authors.initials: TA
authors.lastname: Butt
mesh_terms: D000279:Administration, Cutaneous; D000367:Age Factors; D002990:Clobetasol / Q000009:adverse effects*; D015331:Cohort Studies; D003480:Cushing Syndrome / Q000139:chemically induced* / Q000453:epidemiology; D003963:Diaper Rash / Q000188:drug therapy*; D041381:Diapers, Infant / Q000706:statistics & numerical data; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects*; D006801:Humans; D007049:Iatrogenic Disease; D007223:Infant; D008297:Male; D010154:Pakistan / Q000453:epidemiology; D012307:Risk Factors; D012651:Self Medication / Q000706:statistics & numerical data; D012737:Sex Factors
chemical_list: D005938:Glucocorticoids; D002990:Clobetasol
keywords: Iatrogenic Cushing's syndrome, Nappy rash ointments, Self-medication.