Topical corticosteroid induced osteoporotic vertebral fractures – A case report

A 34-year-old man with a 5-year history of psoriasis had applied topical clobetasol propionate ointment and presented with severe shortness of breath, severe pain all over the body, and no records of previous trauma. Physical examination showed severe psoriasis with striae all over the body, which was associated with a cushingoid appearance. MRI of the dorso-lumbar spine was performed, and the results revealed multilevel chronic compression fractures from D6 to D12 levels with mild mid-body wedgings and chronic adjacent endplate changes. Kyphosis centered at the D8 vertebra was caused by osteoporosis. The patient was diagnosed with Iatrogenic or medication-related Cushing’s syndrome caused by the long-term use of clobetasol propionate. The topical clobetasol ointment was stopped and replaced with systemic hydrocortisone and a once-a-week alendronate tablet. Iatrogenic Cushing's syndrome is most frequently caused by systemic corticosteroid misuse,when strong glucocorticoid, like clobetasol, is applied to the skin and mucosa, the same phenomenon occurs.