Dexamethasone
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Necrotising fasciitis (first report) in an infant, and growth disorder and keratosis pilaris in a child: 2 case reports A female infant developed necrotising fasciitis, and a girl experienced cushingoid growth and keratosis pilaris, while receiving a dexamethasone-containing OTC cream [999; other compounds included menthol and camphor].* Patient 1, a 10-month-old infant girl, had developed a small ulcer near her right labia majora. Her mother started applying 999 cream [dosage not stated] to the ulcer, since the cream had previously been useful in treating minor bruises and skin conditions. However, the girl’s ulcer grew and became purple with yellowish discharge [duration of treatment to reaction onset not stated]. Oral antibiotic therapy did not improve her symptoms and she was hospitalised 1 week later. At that time, the lesion had spread to her periumbilical region, the upper third of her right thigh, her right perineum, vulva and buttocks. Necrotising fasciitis was diagnosed. She underwent five debridement operations during the 7 days following admission; intraoperative findings including a 3cm ulcer at the right ischial tuberosity with surrounding necrotic soft tissue and subcutaneous fat, involving about 9% of her total body surface. She underwent catheterisation and colostomy. Wound cultures grew Pseudomonas, Escherichia coli and Enterococcus, among others. Her antibiotics were changed to meropenem and gentamicin. Her fever resolved and she was transferred to another hospital at the end of week 1. Fournier’s gangrene was diagnosed and she underwent further debridement with skin graft. She subsequently remained at a paediatric ICU for 1 week and then underwent perineal reconstruction. She was discharged 6 weeks later. Patient 2, an 11-year-old girl, had a history of eczema since infancy, and was only poorly compliant with her prescribed emollients (1% hydrocortisone cream, 0.1% mometasone ointment). Instead, her mother started applying 999 cream as an emollient to the girl’s back [dosage not stated]. On clinical assessment, the girl had a cushingoid appearance with accelerated BMI and weight gain (97th and 95th percentile, respectively), but decelerated growth in height (10th percentile). She had severe eczema with keratosis pilaris on her limbs, but lacked apparent skin complications attributable to excessive corticosteroid use [duration of treatment to reaction onsets not stated]. Her mother considered 999 cream to be an emollient, but was then informed about it being a potent corticosteroid and instructed to not use it as an emollient [patient outcome not stated]. Author comment: "In [patient 2], the clinician was concerned that the abnormal BMI and discrepant growth velocities in weight and height might be associated with the CS [corticosteroid] usage. In addition, keratosis pilaris could be aggravated by CS. . . In [patient 1], the application of CS to an infected wound may have further reduced local immunity and contributed to the spread of the necrotizing fasciitis." * The authors also report o
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