clobetasol and Diaper-Rash

Topics: Child; Child, Preschool; Clobetasol; Cushing Syndrome; Diaper Rash; Humans; Infant; Ointments; Steroids

We report an infant with exogenous Cushing syndrome after being treated for 2 months with a potent topical corticosteroid via the mother's application of topical clobetasol for diaper rash without a prescription. We emphasize that potent topical steroids should be used with great caution, especially when used under occlusion (e.g., diaper area) and that parents should be warned about potential side effects of these medications, particularly when used in infants.

Topics: Administration, Topical; Clobetasol; Cushing Syndrome; Diaper Rash; Drug Misuse; Female; Glucocorticoids; Humans; Infant

Topics: Anti-Inflammatory Agents; Clobetasol; Cushing Syndrome; Diaper Rash; Female; Glucocorticoids; Humans; Infant

To study the characteristics of infants and children presenting with iatrogenic Cushing's Syndrome due to nappy rash ointments.. 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.. 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%).. 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.

Topics: Administration, Cutaneous; Age Factors; Clobetasol; Cohort Studies; Cushing Syndrome; Diaper Rash; Diapers, Infant; Female; Glucocorticoids; Humans; Iatrogenic Disease; Infant; Male; Pakistan; Risk Factors; Self Medication; Sex Factors

Topics: Administration, Cutaneous; Candidiasis, Cutaneous; Clobetasol; Cushing Syndrome; Diaper Rash; Glucocorticoids; Humans; Iatrogenic Disease; Infant; Male; Treatment Outcome

A prolonged use of topical corticosteroids can result in Cushing syndrome, though this is less common than with oral or parenteral steroids. Most pediatric cases were due to application of topical steroids for diaper dermatitis. Adverse cardiovascular effects can occur in Cushing syndrome with significant long-term morbidity and mortality, though so far there have been no reports of cardiovascular complications due to excessive usage of topical steroids. We report a 2.5-month-old boy who rapidly developed severe Cushing syndrome induced by the misuse of topical clobetasol, a very potent steroid, without a doctor's prescription as a diaper rash cream, and developed moderate left ventricular hypertrophy and pericardial effusion.

Topics: Administration, Topical; Clobetasol; Cushing Syndrome; Diaper Rash; Humans; Infant; Male; Severity of Illness Index; Skin Cream

Topics: Administration, Topical; Adrenocorticotropic Hormone; Anti-Inflammatory Agents; Clobetasol; Cushing Syndrome; Diaper Rash; Diflucortolone; Drug Overdose; Glucocorticoids; Humans; Hydrocortisone; Infant

Prolonged application of topical steroids transiently suppresses the hypothalamic-pituitary-adrenal axis (HPA). Infants who are exposed to topical corticosteroids have greater risk for Cushing's syndrome or adrenocortical insufficiency caused by suppression of the HPA axis because glucocorticoids are highly absorbed through the diaper area. Here, we report six infants (four girls, two boys) aged between 3 and 8 months who were exposed to potent topical corticosteroids (clobetasol propionate and diflucortolone valerate) by the mother's application without prescription.. We examined the HPA axis and other side effects of the potent glucocorticoid therapy in these infants. After stopping the topical corticosteroid, serum AST, ALT, lipids, morning cortisol and ACTH levels were measured. A low dose ACTH stimulation test was carried out. Hydrocortisone was started for the prevention of glucocorticoid withdrawal syndrome and the dose was gradually decreased. Abdominal ultrasonography was performed to investigate hepatosteatosis.. The ACTH stimulation test showed suppression of the HPA axis in these infants. Hepatomegaly was found in all infants and three of them had hepatosteatosis. Liver transaminase levels were elevated in five infants. Five patients have been followed for 6-14 months. One infant died due to generalized Cytomegalovirus infection.. We emphasize that physicians should be alert for the dangerous side-effects of topical steroids and they should avoid long-term use. Furthermore, parents should be informed about the side-effects when topical steroid treatment is chosen.

Topics: Administration, Topical; Adrenal Insufficiency; Adrenocorticotropic Hormone; Anti-Inflammatory Agents; Clinical Chemistry Tests; Clobetasol; Contraindications; Cushing Syndrome; Diaper Rash; Diflucortolone; Drug Overdose; Fatal Outcome; Female; Glucocorticoids; Humans; Hydrocortisone; Hypothalamo-Hypophyseal System; Infant; Male; Pituitary-Adrenal System

Topics: Administration, Topical; Anti-Inflammatory Agents; Clobetasol; Cushing Syndrome; Diaper Rash; Drug Overdose; Humans; Hydrocortisone; Infant; Male; Ointments; Patient Education as Topic; Treatment Failure