Topical Glucocorticoid-Induced Cushing's Syndrome in a Patient with Erythrodermic Psoriasis: A Case Report

Topical glucocorticoids are widely used in psoriasis treatment but may lead to systemic adverse effects, particularly with prolonged use. While pediatric cases are well-documented, adult-onset iatrogenic Cushing's syndrome from topical corticosteroids remains under-recognized.

A 31-year-old woman with a 10-year history of psoriasis vulgaris self-administered high-potency clobetasol propionate ointment (monthly cumulative dose escalated from 30 g to 100 g over 22 months) under no physician supervision. She presented with erythrodermic psoriasis and Cushingoid features (moon facies, violaceous striae, pitting oedema). Laboratory tests confirmed suppressed cortisol (<1.5 nmol/L) and ACTH (2.86 pg/mL). Management included gradual withdrawal of topical steroids, initiation of oral methylprednisolone (8 mg daily) for HPA axis support, and transition to low-potency desonide. Four-month follow-up showed normalization of cortisol levels (167.1 nmol/L at 8:00 AM).

This case highlights the systemic risks of unsupervised, escalating use of high-potency topical corticosteroids in adults with impaired skin barrier. It underscores the need for adherence to dosing guidelines, patient education, and routine endocrine monitoring.