Linear growth arrest without weight gain due to overuse of topical clobetasol

Area of Science:

• Pediatric Endocrinology
• Dermatology
• Internal Medicine

Background:

• Prolonged use of potent topical glucocorticoids in infants can lead to iatrogenic Cushing's syndrome.
• Iatrogenic Cushing's syndrome is typically associated with obesity, making cases with poor weight gain rare.

Observation:

• A 17-month-old boy presented with growth failure, weighing 9.7kg (5th percentile) and measuring 72cm (-3.6 SD).
• Clinical signs included a moon-like face, hypertrichosis, and thin skin, with a history of seven months of topical clobetasol use for diaper dermatitis.
• Laboratory tests revealed low baseline plasma cortisol and suppressed levels during an adrenocorticotropic hormone stimulation test, indicating secondary adrenal insufficiency.

Findings:

• The patient was diagnosed with secondary adrenal insufficiency and iatrogenic Cushing's syndrome.
• Discontinuation of clobetasol led to successful treatment, with the child's appearance and growth normalizing within two months.
• Morning cortisol levels normalized after treatment, and hydrocortisone was tapered off.

Implications:

• This case underscores the importance of considering iatrogenic Cushing's syndrome in infants with growth failure, even without obesity.
• It highlights the potential for significant endocrine disruption from potent topical steroid use.
• Early diagnosis and management by discontinuing the offending agent are crucial for favorable outcomes in pediatric patients.