Iatrogenic Cushing Syndrome — SCE Dermatology MCQ

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EasyDrug ReactionsIatrogenic Cushing SyndromeSCE Dermatology

A 52-year-old man on long-term systemic Prednisolone for bullous pemphigoid has developed multiple purplish atrophic striae on his abdomen and proximal thighs, easy bruising, and facial plethora. What is this pattern of adverse effects called?

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Correct answer: A — Iatrogenic Cushing syndrome

Iatrogenic Cushing syndrome results from prolonged supraphysiological exogenous corticosteroid use. Cutaneous features include purple striae (from dermal atrophy and capillary fragility), easy bruising, facial plethora/moon face, dorsal fat pad (buffalo hump), skin atrophy, and impaired wound healing. Systemic features include hyperglycaemia, hypertension, osteoporosis, and adrenal suppression. BAD guidelines emphasise the importance of steroid-sparing agents in bullous pemphigoid management and the role of Doxycycline (BLISTER trial) as a first-line option to reduce steroid exposure.

Reference: BAD 2012 BP Guidelines; BNF Corticosteroid side effects