Adrenocortical corticotropic insufficiency secondary to the use of cosmetic dermocorticoids

Abstract

Voluntary depigmentation or artificial depigmentation for cosmetic purposes is a very widespread phenomenon in Africa. The prevalence reported by several authors varies from 26 to 67%. The complications linked to their use are numerous and less known by the population. We report two cases of acute adrenocortical insufficiency secondary to the use of cosmetic dermocorticoids in diabetic patients aged 40 and 53 years respectively. They were admitted with signs of ketoacidosis decompensation which were similar to signs of acute adrenal insufficiency. The cases’ history revealed that they were using dermocorticoids. The clinical examination identified in both patients a systemic inflammatory response syndrome and general depigmentation. The 40-year-old patient had erysipelas of the left leg and the 53-year-old patient had a diabetic foot with a neuropathic and infectious mechanism. Laboratory tests revealed hyperglycemia, massive acetonuria and a low 8-hour cortisol. The clinical outcome was favorable after hydro-electrolytic rehydration, hourly intravenous insulin therapy, hydrocortisone and antibiotic therapy. Corticotropic insufficiency secondary to voluntary depigmentation by dermocorticoids is a complication that should be systematically sought in any subject using dermocorticoids. Hydrocortisone substitution should be done without delay in the event of confirmed corticotropic insufficiency.