Évolution fatale liée à l’abus de dermocorticoïdes chez un adulte

Introduction

Topical corticosteroids are widely used in the management of chronic inflammatory dermatoses with impaired skin barrier, such as atopic dermatitis and psoriasis. However, their long-term use can lead to systemic effects due to percutaneous absorption. We report a case illustrating the severity of complications associated with excessive use of these medications.

Observation

A 32-year-old woman had been under follow-up for a dermatologic condition with a relapsing-remitting course, evolving since the age of 3. She was initially treated with a high-potency topical corticosteroid, which led to good improvement. However, she continued self-administering topical corticosteroids for 22 years. She presented with erythroderma characterized by desquamation, edema, and erosions in some areas. The clinical presentation, along with excessive use of betamethasone, suggested iatrogenic Cushing's syndrome. Laboratory tests revealed corticotropic adrenal insufficiency. A skin biopsy confirmed the diagnosis of atopic dermatitis. Management included treatment of fungal, infectious, and metabolic complications. Hydrocortisone was initiated, and after education, topical corticosteroids were replaced with topical tacrolimus. The patient was lost to follow-up and succumbed to adrenal insufficiency one month later.

Conclusion

This case highlights the severity of iatrogenic complications secondary to misuse of topical corticosteroids and underscores the need for proper therapeutic education and adequate follow-up.