Betamethasone misuse

Abstract

Various toxicities: case report A 38-year-old woman developed Cushing’s syndrome, corticotropic insufficiency and inframammary, axillary, intergluteal superinfected intertrigo, necrotic leg wounds, skin atrophy, septic shock and acute adrenal insufficiency secondary to misuse of betamethasone for pruritus. The woman, who had Netherton syndrome, was admitted due to necrotic leg wounds, which were developed on severe skin atrophy. She had been applying topical betamethasone since 10 years for severe pruritus. She used an estimated amount of 7.2 kg/year of betamethasone, which was determined to be an excessive use for topical drug (misuse) [exact amount of drug application and frequency of drug application not stated]. On examination, she was found to have developed Cushing’s syndrome, osteoporosis, corticotropic insufficiency and inframammary, axillary and intergluteal superinfected intertrigo. During the hospital course, she developed fracture on falling down. Further, she developed septic shock, which was complicated by acute adrenal insufficiency leading to multi-organ failure and died eventually. All these complications were attributed to the misuse of topical betamethasone [duration of treatment to reactions onsets not stated]. Author comment: This case illustrates the severity of iatrogenic effects secondary to misuse of topical corticosteroids. In NS, the adverse effects of topical corticosteroids are amplified due to the major defect in the skin barrier which enhancesthe systemic passage of these drugs.