Topical steroids are creams or ointments frequently used in dermatology, pediatric medicine, and rheumatology. The most famous topical steroid is probably hydrocortisone, used to treat skin conditions for 70 years.
Cushing syndrome is a disease that occurs when the body produces abnormally high levels of cortisol hormone due to either prolonged exposure to high-dose glucocorticoid (steroid) medications or tumors that secrete cortisol directly into the bloodstream. Multiple factors can cause elevated circulating cortisol, such as chronic inflammation, autoimmune diseases (such as lupus), osteoporosis, and certain cancers like lymphoma and leukemia.
Who does what?
Dermatologists prescribe/use topical steroids to treat inflammatory skin conditions (such as psoriasis, acne, and dermatitis) and allergic reactions. Rheumatologists also prescribe/use topical steroids to treat arthritis, and many pediatricians use them for eczema in infants and children.
What do we know?
Excessive use of topical steroids can cause Cushing syndrome (hypercortisolism). Although this is uncommon, it has been reported in the literature when topical steroid abuse is extensive. Still, there have been no reports of Cushing syndrome from using a small number of topical steroids once or twice a day over short periods. In other words, you would have to take an excessive dose or apply too much for too long before you develop Cushing syndrome.
What do we recommend?
If you see your dermatologist or pediatrician for treatment of a skin condition, please explain that you are concerned about this new diagnosis and ask what the safest options available to you are. Your doctor can prescribe other medications (retinoids, tacrolimus, etc.) or recommend alternative therapy with appropriate treatment steps to help minimize the risk of developing Cushing syndrome. Please always remember to follow your physician’s instructions during treatment.
It is highly recommended to avoid potentially harmful steroids, especially when there is no need for them due to their severe side effects, including Cushing syndrome and cataracts, glaucoma, increased blood pressure, and osteoporosis, among many others.
Citations: Wong PF, Chan HH, Chu TK. What is the relation between topical steroids and Cushing syndrome? Int J Clin Pract 2015;69(7):874-876. doi:10.1111/ijcp.12803