A case of von Zumbusch psoriasis and Cushing syndrome induced by prednisone and clobetasol ointment in a pediatric patient

Authors: Therese Catherine R. Acero, MD, Rogelio A. Balagat MD, FPCP, FPDS, FPRA, Charlene A. Tiu, MD, FPDS,  Lily Lyralin Laconico-Tumalad, MD, FPDS

Abstract

Introduction: Oral and topical glucocorticoids are widely used in dermatology. They are effective but their side effects are serious, ranging from skin atrophy to life-threatening conditions such as Cushing syndrome and sepsis. The coexistence of Von Zumbusch psoriasis and Cushing syndrome in a pediatric patient is rare.

Case Summary: This is a case of a 15-year old girl who had flares of von Zumbusch psoriasis and developed Cushing syndrome from long use of systemic and super potent topical glucocorticoids. It started as guttate psoriasis spontaneously progressing to von Zumbusch psoriasis. Subsequent episodes of von Zumbusch psoriasis presented as multiple, scattered 1 to 3 pustules on the trunk, forehead, both upper and lower extremities with some coalescing to form lakes of pus and patchy areas of desquamation.  These flares were attributed to the withdrawal of systemic glucocorticoids and to upper respiratory and urinary tract  infections. She also presented with moon facies and purple striae consistent with Cushing syndrome.

Conclusion: A systemic glucocorticoid should not be used to treat psoriasis because of the significant risk of developing von Zumbusch psoriasis and Cushing syndrome as shown in this case. Significant systemic absorption occurs with extensive use of potent topical  glucocorticoids over long periods and represents the same risk posed by systemic glucocorticoids.

 

Citation

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Keywords

von Zumbusch psoriasis, Cushing syndrome, topical and systemic glucocorticoids

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