Topical Steroid-Induced Cushing Syndrome in an 18-Month-Old Child: A Case Report

Topical corticosteroids are widely used in pediatric dermatology and are generally considered safe when used appropriately; however, prolonged or inappropriate use, particularly of high-potency agents, may lead to significant systemic adverse effects. This case report describes an 18-month-old female who presented with rapid weight gain and cushingoid features following prolonged application of clobetasol propionate for diaper dermatitis. Clinical evaluation revealed generalized obesity, moon facies, facial plethora, and dorsal hypertrichosis, while laboratory investigations demonstrated markedly suppressed afternoon serum cortisol levels (~2 µg/dL; pediatric reference range: 3-13 µg/dL) and plasma adrenocorticotropic hormone (ACTH) levels <5 pg/mL (pediatric reference range: 10-60 pg/mL), consistent with hypothalamic-pituitary-adrenal axis suppression. Imaging studies exclude adrenal pathology. Discontinuation of the offending agent and close clinical monitoring resulted in gradual improvement of clinical features and partial recovery of HPA axis function. This case underscores the potential for potent topical corticosteroids to induce systemic complications in infants and highlights the importance of cautious prescribing, caregiver education, and early recognition of steroid-related adverse effects in pediatric patients.