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Psoriatic erythroderma and hypothalamus-pituitary axis suppression due to misuse of systemic steroid: two challenging cases.

Singh GK, Chatterjee M - Indian J Dermatol (2015 Mar-Apr)

Bottom Line: Tapering of systemic steroid in first case and discontinuation of homeopathic drug in second case resulted in erythroderma and features of adrenal insufficiiency.Investigation revealed low morning cortisol and low cortisol following ACTH stimulation suggestive of HPA axis suppression.Planned withdrawal of steroid under the cover of short acting systemic steroid for short duration along with combination of immunosuppressants and supportive care gave an excellent result in both the cases.

View Article: PubMed Central - PubMed

Affiliation: Classified specialist, MH Ahmedabad, Gujrat, (Dermatology, Venereology and Leprosy), Command Hospital, Eastern Command, Kolkata, West Bengal, India.

ABSTRACT
Adding corticosteroid in homeopathic pills, self medication of steroid in the backdrop permanent cure in cases of psoriasis is not very uncommon in clinical practice in Indian subcontinent. First case a 52 year man, a known case of psoriasis vulgaris with psoriatic arthropathy of 15 years duration received multiple modalities of therapies without any satisfactory response. He was on self medication of tab prednisolone 10 mg daily with Cushingoid features. Second case a 22 year old boy, a known case of psoriasis from last 06 years was on Homeopathic treatment with Cushinoid features. Tapering of systemic steroid in first case and discontinuation of homeopathic drug in second case resulted in erythroderma and features of adrenal insufficiiency. Investigation revealed low morning cortisol and low cortisol following ACTH stimulation suggestive of HPA axis suppression. Planned withdrawal of steroid under the cover of short acting systemic steroid for short duration along with combination of immunosuppressants and supportive care gave an excellent result in both the cases.

No MeSH data available.


Related in: MedlinePlus

(a) Erythema and scaling with striae on the left shoulder and chest. (b) Erythema and scaling with striae on the right shoulder and chest. (c) Erythema and scaling with superficial lakes of pus on the back
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Figure 2: (a) Erythema and scaling with striae on the left shoulder and chest. (b) Erythema and scaling with striae on the right shoulder and chest. (c) Erythema and scaling with superficial lakes of pus on the back

Mentions: His psoriatic lesions along with psoriatic arthropathy have shown significant regression over 02 months [Figure 2]. His prednisolone was gradually tapered and stopped over one and half months. There has been no flare of psoriasis as well as arthropathy since last admission. He is maintained on injection methotrexate 7.5 mg/week and 25 mg eternacept SC/weekly with supportive bland emollient.


Psoriatic erythroderma and hypothalamus-pituitary axis suppression due to misuse of systemic steroid: two challenging cases.

Singh GK, Chatterjee M - Indian J Dermatol (2015 Mar-Apr)

(a) Erythema and scaling with striae on the left shoulder and chest. (b) Erythema and scaling with striae on the right shoulder and chest. (c) Erythema and scaling with superficial lakes of pus on the back
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4372917&req=5

Figure 2: (a) Erythema and scaling with striae on the left shoulder and chest. (b) Erythema and scaling with striae on the right shoulder and chest. (c) Erythema and scaling with superficial lakes of pus on the back
Mentions: His psoriatic lesions along with psoriatic arthropathy have shown significant regression over 02 months [Figure 2]. His prednisolone was gradually tapered and stopped over one and half months. There has been no flare of psoriasis as well as arthropathy since last admission. He is maintained on injection methotrexate 7.5 mg/week and 25 mg eternacept SC/weekly with supportive bland emollient.

Bottom Line: Tapering of systemic steroid in first case and discontinuation of homeopathic drug in second case resulted in erythroderma and features of adrenal insufficiiency.Investigation revealed low morning cortisol and low cortisol following ACTH stimulation suggestive of HPA axis suppression.Planned withdrawal of steroid under the cover of short acting systemic steroid for short duration along with combination of immunosuppressants and supportive care gave an excellent result in both the cases.

View Article: PubMed Central - PubMed

Affiliation: Classified specialist, MH Ahmedabad, Gujrat, (Dermatology, Venereology and Leprosy), Command Hospital, Eastern Command, Kolkata, West Bengal, India.

ABSTRACT
Adding corticosteroid in homeopathic pills, self medication of steroid in the backdrop permanent cure in cases of psoriasis is not very uncommon in clinical practice in Indian subcontinent. First case a 52 year man, a known case of psoriasis vulgaris with psoriatic arthropathy of 15 years duration received multiple modalities of therapies without any satisfactory response. He was on self medication of tab prednisolone 10 mg daily with Cushingoid features. Second case a 22 year old boy, a known case of psoriasis from last 06 years was on Homeopathic treatment with Cushinoid features. Tapering of systemic steroid in first case and discontinuation of homeopathic drug in second case resulted in erythroderma and features of adrenal insufficiiency. Investigation revealed low morning cortisol and low cortisol following ACTH stimulation suggestive of HPA axis suppression. Planned withdrawal of steroid under the cover of short acting systemic steroid for short duration along with combination of immunosuppressants and supportive care gave an excellent result in both the cases.

No MeSH data available.


Related in: MedlinePlus