Systemic toxicity to betamethasone ointment

Area of Science:

• Dermatology and Pharmacology

Background:

• Actinic keratosis (AK) is a common pre-malignant skin condition.
• Topical corticosteroids, like betamethasone, are frequently used for AK treatment.
• Systemic absorption and potential side effects of topical steroids are a known concern.

Observation:

• A 59-year-old male patient with scalp AK presented with new-onset systemic symptoms.
• Symptoms included fatigue, somnolence, vertigo, nausea, sleep disturbance, cognitive changes, visual impairment, and hypertension.
• These symptoms emerged shortly after initiating topical betamethasone/diclofenac ointment.

Findings:

• The patient's constellation of symptoms was attributed to systemic absorption of betamethasone (a glucocorticoid).
• All reported adverse effects completely resolved within 48 hours of discontinuing the topical medication.
• This case highlights the potential for significant systemic glucocorticoid toxicity from topical application.

Implications:

• Clinicians should be vigilant for systemic side effects when prescribing topical betamethasone, especially for widespread or long-term use.
• Monitoring for symptoms like fatigue, cognitive changes, and hypertension is crucial in patients using topical glucocorticoids.
• Discontinuation of the causative agent is an effective strategy for managing systemic side effects of topical betamethasone.