Osteoporotic vertebral fracture caused by topical corticosteroid abuse: A case report

Piaserico,Stefano; Linder,Dennis; Messina,Francesco; Alaibac,Mauro

doi:10.3892/etm.2019.7825

Osteoporotic vertebral fracture caused by topical corticosteroid abuse: A case report

Authors:
- Stefano Piaserico
- Dennis Linder
- Francesco Messina
- Mauro Alaibac
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Affiliations: Dermatology Unit, Department of Medicine, University of Padua, Padua I‑35128, Italy, Department of Dermatology and Venereology, Ben Gurion University of The Negev, Beer‑Sheva 84101, Israel
Published online on: July 30, 2019 https://doi.org/10.3892/etm.2019.7825
Pages: 2746-2748

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Abstract

In the present case report, a 32‑year‑old man with a 20‑year long history of psoriasis, who presented with severe lower back pain and had no records of previous trauma, is reported. The patient reported the regular use of clobetasol cream, for 8 years, at an average dosage of 100 grams (g) per week. At the time of visit, the patient presented with severe psoriasis, which was associated with a cushingoid appearance. An X‑ray of the spine was performed and the results revealed diffuse vertebral collapse that was caused by osteoporosis. The patient was diagnosed with iatrogenic Cushing's syndrome caused by the long‑term use of clobetasol 17‑propionate cream. The topical clobetasol treatment was stopped and replaced with infliximab infusions. Complete control of the disease was subsequently achieved. Iatrogenic Cushing's syndrome is generally caused by systemic corticosteroid abuse. However, the topical application of potent glucocorticoids, including clobetasol treatment on the skin and mucosae, results in the same syndrome.

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1	Tempark T, Phatarakijnirund V, Chatproedprai S, Watcharasindhu S, Supornsilchai V and Wananukul S: Exogenous Cushing's syndrome due to topical corticosteroid application: Case report and review of the literature. Endocrine. 38:328–334. 2010. View Article : Google Scholar : PubMed/NCBI
2	Decani S, Federighi V, Baruzzi E, Sardella A and Lodi G: Iatrogenic Cushing's syndrome and topical steroid therapy: Case series and review of the literature. J Dermatolog Treat. 25:495–500. 2014. View Article : Google Scholar : PubMed/NCBI
3	Dutta D, Shivaprasad KS, Ghosh S, Mukhopadhyay S and Chowdhury S: Iatrogenic Cushing's syndrome following short-term intranasal steroid use. J Clin Res Pediatr Endocrinol. 4:157–159. 2012. View Article : Google Scholar : PubMed/NCBI
4	Kao JS, Fluhr JW, Man MQ, Fowler AJ, Hachem JP, Crumrine D, Ahn SK, Brown BE, Elias PM and Feingold KR: Short-term glucocorticoid treatment compromises both permeability barrier homeostasis and stratum corneum integrity: Inhibition of epidermal lipid synthesis accounts for functional abnormalities. J Invest Dermatol. 120:456–464. 2003. View Article : Google Scholar : PubMed/NCBI
5	Ermis B, Ors R, Tastekin A and Ozkan B: Cushing's syndrome secondary to topical corticosteroids abuse. Clin Endocrinol (Oxf). 58:795–796. 2003.PubMed/NCBI
6	Gilbertson EO, Spellman MC, Piacquadio DJ and Mulford MI: Super potent topical corticosteroids use associated with adrenal suppression: Clinical consideration. J Am Acad Dermatol. 38:318–321. 1998. View Article : Google Scholar : PubMed/NCBI
7	Ohman EM, Rogers S, Meenan FO and McKenna TJ: Adrenal suppression following low-dose opical clobetasol propionate. J R Soc Med. 80:422–424. 1987. View Article : Google Scholar : PubMed/NCBI
8	Ohnishi T, Suzuki T, Watanabe S and Takahashi H: Erythrodermic psoriasis associated with hyperuricemia and iatrogenic Cushing's syndrome due to topical corticosteroid therapy. Int J Dermatol. 35:379–380. 1996. View Article : Google Scholar : PubMed/NCBI
9	Keipert JA and Kelly R: Temporary Cushing's syndrome from percutaneous absorption of betamethasone 17-valerate. Med J Aust. 1:542–544. 1971.PubMed/NCBI
10	Young CA, Williams IR and MacFarlane IA: Unrecognised Cushing's syndrome and adrenal suppression due to topical clobetasol propionate. Br J Clin Pract. 45:61–62. 1991.PubMed/NCBI
11	Gönül M and Gönül E: A case of multiple bone fractures due to the use of topical corticosteroid therapy for psoriasis. J Dermatolog Treat. 26:215–216. 2015. View Article : Google Scholar : PubMed/NCBI
12	Compston J: Glucocorticoid-induced osteoporosis: An update. Endocrine. 61:7–16. 2018. View Article : Google Scholar : PubMed/NCBI
13	Haroon NN, Sriganthan J, Al Ghanim N, Inman RD and Cheung AM: Effect of TNF-alpha inhibitor treatment on bone mineral density in patients with ankylosing spondylitis: A systematic review and meta-analysis. Semin Arthritis Rheum. 44:155–161. 2014. View Article : Google Scholar : PubMed/NCBI
14	Molnár I, Bohaty I and Somogyiné-Vári É: IL-17A-mediated sRANK ligand elevation involved in postmenopausal osteoporosis. Osteoporos Int. 25:783–786. 2014. View Article : Google Scholar : PubMed/NCBI
15	Shukla P, Mansoori MN and Singh D: Efficacy of anti-IL-23 monotherapy versus combination therapy with anti-IL-17 in estrogen deficiency induced bone loss conditions. Bone. 110:84–95. 2018. View Article : Google Scholar : PubMed/NCBI