Endocrine Abstracts

JOINT2546

Introduction: Skin lightening creams contain steroids and are easily accessible from over the internet and shops which are not regulated. Topical corticosteroids have important anti-inflammatory and immunosuppressive activity and are often prescribed for the treatment of dermatological disorders such as eczema and psoriasis. Adrenal insufficiency has been known to be a side effect for using topical steroid creams for long period of time and are therefore prescribed and monitored by the dermatologist.

Case Presentation: 35-year-old female presented with 1-year history of lethargy, fatigue and muscle cramps which had got worse in the last one week. No infective signs. She was haemodynamically stable and apyrexic. She has a past medical history of depression and anxiety and was taking mirtazapine medication. Her menstrual cycle is regular and has two children. Her 9am Cortisol was found to be 7 nmmol/l and the pH, lactate and glucose was within normal range. She denied taking oral or inhaled steroids but on further questioning it was found she has been taking a skin lightening cream call ‘Fashion fair cream’ which contains clobetasol propionate. She had been using this cream all over her body for many years. On examination her skin had different pigmentation, thinner with more prominent veins. She had multiple striae on her arms, thighs and abdomen. She also looked cushingoid with moon face, central obesity, buffalo hump of neck, and striae all over the body significantly on the abdomen. Short synacthen test showed cortisol levels of 8nmol/l(0mins), 106 nmol/l(30mins) and 73 nmol/l(60mins). She was reviewed in the endocrine clinic where she was advised to stop her topical cream and started on hydrocortisone 10 mg/5 mg/5 mg with aim to wean down slowly

Conclusion: Many skin lightening creams contain steroids which patients may not be aware of. Long-term use of topical steroid cream can cause side effects and most importantly secondary adrenal insufficiency. Although commonly prescribed for dermatological conditions such as eczema and psoriasis they are monitored closely. However, skin lightening creams are not monitored and are easily available without prescription or monitoring from shops and online. This could lead to adrenal insufficiency if used for longer period of times. It is important to take a full history to check if patients are taking topical cream, eye drops, etc that may contain steroids. It is also important to have an MDT approach with the dermatologist and endocrinologist to help wean patient off the steroids and treat appropriately.