Xing Peng,1 Gen Quan,2 Xiao-Guang She,1 Jing-Jing Wu,2 Qin Ge2 

1Department of Dermatology, Jingmen Central Hospital, Jingmen Central Hospital Affiliated to Jingchu University of Technology, Jingmen, 448000, People’s Republic of China; 2Department of Dermatology, Wuhan Asia General Hospital, Wuhan Asia General Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, 430000, People’s Republic of China

Correspondence: Qin Ge, Department of Dermatology, Wuhan Asia General Hospital, Wuhan Asia General Hospital Affiliated to Wuhan University of Science and Technology, No. 300, Taizihu North Road, Economic and Technological Development District, Wuhan, 430000, People’s Republic of China, Tel +86 18772720079, Email geqin.whyx@outlook.com

Background: Topical glucocorticoids are widely used in psoriasis treatment but may lead to systemic adverse effects, particularly with prolonged use. While pediatric cases are well-documented, adult-onset iatrogenic Cushing’s syndrome from topical corticosteroids remains under-recognized.
Case Presentation: A 31-year-old woman with a 10-year history of psoriasis vulgaris self-administered high-potency clobetasol propionate ointment (monthly cumulative dose escalated from 30 g to 100 g over 22 months) under no physician supervision. She presented with erythrodermic psoriasis and Cushingoid features (moon facies, violaceous striae, pitting oedema). Laboratory tests confirmed suppressed cortisol (< 1.5 nmol/L) and ACTH (2.86 pg/mL). Management included gradual withdrawal of topical steroids, initiation of oral methylprednisolone (8 mg daily) for HPA axis support, and transition to low-potency desonide. Four-month follow-up showed normalization of cortisol levels (167.1 nmol/L at 8:00 AM).
Conclusion: This case highlights the systemic risks of unsupervised, escalating use of high-potency topical corticosteroids in adults with impaired skin barrier. It underscores the need for adherence to dosing guidelines, patient education, and routine endocrine monitoring.

Keywords: Cushing’s syndrome, dermatologic diseases, erythroderma, glucocorticoids, psoriasis