Clobetasol overdose
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Cushing’s syndrome: case report A 35-year-old woman developed full-blown Cushing’s syndrome, with type 2 diabetes mellitus and osteoporosis with vertebral fractures, following the long-term topical administration of excessive quantities of clobetasol cream to "treat" ichthyosis [initial dosage and duration of therapy to reaction onset not stated]. The woman was hospitalised with multiple vertebral fractures and suspected spinal cord compression. She had developed type 2 diabetes mellitus 2 years earlier, and was receiving treatment. On examination, she exhibited a typical Cushingoid appearance and radiologic examination showed crush fractures of the corpora of thoracic vertebrae 6, 7 and 9. Her urine free cortisol and serum adrenocorticotropic hormone [ACTH] and cortisol levels were immeasurably low. Cushing’s syndrome caused by an exogenous source of corticosteroids was suspected and it was revealed that she had been applying clobetasol cream 0.5 mg/g for years, and had applied one 25g tube per day to a large skin area during the previous year (total dose for year 8800g). Clobetasol was discontinued and the woman received bisphosphonates and a tapering dose of hydrocortisone. She underwent several months of treatment and convalescence, and was doing well, but continued to require hydrocortisone. Author comment: "Clobetasol is contra-indicated in icthyosis [sic], its maximum dose is 50g per week applied topically for a maximum of two weeks at a stretch. . . [T]his female suffered from a full-blown Cushing’s syndrome caused by excessive use of clobetasol cream, which induced a very vulnerable, atrophic skin, diabetes mellitus and osteoporosis with vertebral fractures, affecting the spinal cord". Seebus E, et al. A full-blown Cushing’s syndrome from a cream tube. 90th Annual Meeting of the Endocrine Society : abstr. P2-780, 16 Jun 2008. 801114663 Netherlands
0114-9954/10/1207-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 21 Jun 2008 No. 1207
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