28/02/2024
Public service message
Do not use steroid cream for nappy rash.examples travocort.hydrozole.aquazole.betnovate.dermovate.cutivate.
Use only peds cream or cutipro cream.
Steroids creams can cause iatrogenic cushing syndome
An 8-month-old infant was brought in by her mother with a history of generalized weight gain, puffiness of the face, and increased irritability over the past few weeks. The mother admitted to applying a potent topical steroid cream on the baby's diaper area several times daily for the past two months, obtained over-the-counter for a persistent nappy rash. On examination, the infant had moon facies, a rounded abdomen with prominent striae, and thinning of the skin in the diaper region.
These findings were consistent with iatrogenic Cushing syndrome due to excessive absorption of high-potency topical steroids in an infant with a large surface area relative to body mass. The condition is rare but serious, especially in young children with prolonged unsupervised steroid use.
The mother was counseled to immediately stop the steroid cream and switch to gentle barrier creams and appropriate hygiene measures for nappy rash. The infant was referred to a pediatric endocrinologist for evaluation of adrenal suppression and supportive care. Close monitoring for symptoms of adrenal insufficiency was planned. Education regarding the dangers of unsupervised steroid use was emphasized.