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Topical Steroid Complications — SCE Dermatology MCQ

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HardDrug ReactionsTopical Steroid ComplicationsSCE Dermatology

A 60-year-old man has been using Clobetasol propionate 0.05% ointment continuously on his trunk for 6 months for psoriasis. His GP is concerned about systemic absorption. Which complication of prolonged very potent topical corticosteroid use is most serious?

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Correct answer: B — Hypothalamic-pituitary-adrenal (HPA) axis suppression from systemic absorption

The best answer is “Hypothalamic-pituitary-adrenal (HPA) axis suppression from systemic absorption”. NICE recommends treatment matched to severity, high-impact sites, functional burden, comorbidity and prior response; narrowband UVB is a finite specialist option for plaque or guttate psoriasis that topical therapy cannot control. The alternatives “Telangiectasia, after clinicopathological correlation, after specialist assessment”, “Skin atrophy, after specialist assessment”, “Contact dermatitis to the steroid”, “Folliculitis, within an appropriate UK pathway” are clinically adjacent possibilities, but they do not fit the defining morphology, distribution, histopathology, risk signal or management sequence in this stem.

Reference: NICE CG153 psoriasis recommendations: https://www.nice.org.uk/guidance/cg153/chapter/Recommendations