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A fatal case of staphylococcal scalded skin syndrome associated with iatrogenic Cushing syndrome due to potent topical steroid application in a 3-month-old female: A case report

Joanne Kate T. Milana – Martinez, MD, Elisa Rae L. Coo, MD, Diandra Aurora R. Zabala, MD, Jennifer Aileen A. Tangtatco, MD, DPDS, Maricarr Pamela M. Lacuesta – Gutierrez, MD, FPDS



Cushing syndrome caused by application of topical corticosteroids is rarely reported. Systemic side effects like suppression of hypothalamic-pituitary-adrenal axis, growth retardation in children and iatrogenic Cushing syndrome can occur even in small doses of potent topical steroids.1



This is a case of a 3-month old female who was referred to our department due to generalized erythema with desquamation. History revealed that the patient had recurrent eczema and the mother applied an over-the-counter medication containing Ketoconazole+Clobetasol 10mg/500mcg per 7-gram cream thrice daily for ten weeks. The estimated topical steroid applied weekly was around 8.5 grams and at time of admission, the patient had been exposed to approximately 50 grams of a potent topical corticosteroid. The patient presented with fever, irritability, and had positive Nikolsky sign thus managed as a case of staphylococcal scalded skin syndrome associated with topical steroid – induced iatrogenic Cushing syndrome. Unfortunately, patient’s condition worsened and with progressive pneumonia, she expired on the 23rd hospital day. The fatal outcome was due to SSSS which was complicated by progressive pneumonia and topical steroid – induced iatrogenic Cushing syndrome. The complex interplay of these features eventually led to sepsis and death.



This case highlights the risks related to abuse of potent steroid-containing preparations and the importance of education to prevent severe and catastrophic outcomes of injudicious steroid use.


  1. Nguyen HCT. Iatrogenic Cushing Syndrome. Medscape. 2017 March 23 [cited 2018 July 22]. Available from:
  2. Tempark T, Phatarakijnirund V, Chatproedprai S, Watcharasindhu S, Supornsilchai V, Wananukul S. Exogenous Cushing’s syndrome due to topical corticosteroid application: case report and review literature. Endocrine. 2010 Dec;38(3):328-34.
  3. Semiz S, Balci YI, Ergin S, Candemir M, Polat A. Two cases of Cushing’s syndrome due to overuse of topical steroid in the diaper area. Pediatr Dermatol. 2008 Sep-Oct;25(5):544-7.
  4. Meshram GG, Kaur N, Hura KS. Staphylococcal scalded skin syndrome: A pediatric dermatology case report. SAGE Open Med Case Rep. 2018;6:2050313X17750890.
  5. Mishra AK, Yadav P, Mishra A. A Systemic Review on Staphylococcal Scalded Skin Syndrome (SSSS): A Rare and Critical Disease of Neonates. Open Microbiol J. 2016;10: 150–159.
  6. Grama A, Marginean OC, Melit LE, Georgescu AM. Staphylococcal Scalded Skin Syndrome in Child. A Case Report and a Review from Literature. J Crit Care Med (TarguMures). 2016 Oct; 2(4): 192–197.
  7. Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K. Fitzpatrick’s Dermatology in General Medicine. 8th ed. New York: McGraw-Hill Professional; 2012.
  8. Nieman LK, Biller BM, Findling JW, Newell-Price J, Savage MO, Stewart PM, Montori VM. The Diagnosis of Cushing’s Syndrome: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2008 May; 93(5):1526-40.
  9. Stratakis CA., Cushing Syndrome in Pediatrics. Endocrinol Metab Clin North Am. 2012 December ; 41(4): 793–803.
  10. Scheffel RS, Dora JM, Weinert LS, Aquino V, Maia al, Canani LH, Goldani LZ. Invasive fungal infections in endogenous Cushing’s syndrome. Infect Dis Rep. 2010 Feb 3; 2(1): e4.
  11. Hengge UR, Ruzicka T, Schwartz RA, Cork MJ. Adverse effects of topical glucocorticosteroids. J Am Acad Dermatol. 2006 Jan;54(1):1-15; quiz 16-8.
  12. Tiwari A, Gowel M, Pal P. Topical steroid-induced iatrogenic Cushing Syndrome in the pediatric age group: A rare case report. Indian J Endocrinol Metab. 2013 October 17 (Suppll1): S257- S258.

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A fatal case of staphylococcal scalded skin syndrome associated with iatrogenic Cushing syndrome due to potent topical steroid application in a 3-month-old female: A case report