Pediatric iatrogenic Cushing's syndrome: a series of seven cases induced by topical corticosteroid use

Objectives Cushing's syndrome (CS) in children is often caused by prolonged glucocorticoid use. Exogenous steroid administration, mainly oral and parenteral, commonly leads to iatrogenic CS, while topical corticosteroids' role is less recognized. Here, we present seven pediatric cases of iatrogenic CS linked to topical glucocorticoids, resulting in adrenal insufficiency.Case presentation There were seven patients, aged 3-60 months, with diaper dermatitis (six patients) and scabies (one patient), all receiving topical clobetasol propionate for a median duration of 2 months (range: 0.5-3 months). Adrenal insufficiency was detected in all cases and treated with hydrocortisone at a median dose of 10 mg/m2/day (range: 7.5-50 mg/m2). One infant also had hypercalcemia. Clinical findings and anthropometric measurements normalized during follow-up, with a median hypothalamic-pituitary-adrenal axis recovery time of 6 months (range: 4-9 months).Conclusions This study contributes valuable insights into the management of iatrogenic CS in pediatric patients and emphasizes the need for cautious prescribing practices to safeguard against adverse effects.