Vincenzo Bettoli 1 , MD Sara Minghetti 1 , MD Paola Ferron 2 , MD Alessandro Borghi 1 , MD Annarosa Virgili 1 , MD Departments of 1 Clinical and Experimental Medicine, Section of Dermatology and 2 Experimental and Diagnostic Medicine, Section of Pathology, University of Ferrara, Ferrara, Italy Vincenzo Bettoli, MD Departments of Clinical and Experimental Medicine Section of Dermatology University of Ferrara Via Savonarola 9, 44100 Ferrara, Italy E-mail: vincenzo.bettoli@fastwebnet.it References 1 Bechet PE. Hypertrophic lupus erythematosus. Arch Derm Syphilol 1940; 42: 211–213. 2 Al-Mutairi N, Rijhwani M, Nour-Eldin O. Hypertrophic lupus erythematosus treated successfully with acitretin as monotherapy. J Dermatol 2005; 32: 482–486. 3 Suwattee P, Cham PMH, Werling RW, et al. Challenge. Am J Dermatopathol 2008; 30: 635. 4 Fabbri P, Cardinali C, Giomi B, et al.. Cutaneous lupus erythematosus. Am J Clin Dermatol 2003; 4: 449–465. 5 Uitto J, Santa-Cruz DJ, Eisen AZ, et al.. Verrucous lesions in patients with discoid lupus erythematosus. Br J Dermatol 1978; 98: 507–520. 6 Daldon PE, Macedo de Souza E, Cintra ML. Hypertrophic lupus erythematosus: a clinicopathological study of 14 cases. J Cutan Pathol 2003; 30: 443–448. 7 Green SJ, Piette WW. Successful treatment of hypertrophic lupus erythematosus with isotretinoin. J Am Acad Dermatol 1987; 17: 364–368. 8 Rubenstein DJ, Huntley AC. Keratotic lupus erythematosus: treatment with isotretinoin. J Am Acad Dermatol 1986; 14: 910–914. 9 Seiger E, Roland S, Goldman S. Cutaneous lupus treated with topical tretinoin: a case report. Cutis 1991; 47: 351–355. Cushing’s syndrome induced by high-potency topical corticosteroids Editor, A 13-year-old girl was admitted to our outpatient clinic for psoriatic lesions which had increased during recent months. She had had psoriasis for nine years and for the past five years had used clobetasol propionate 0.05% ointment continuously at 100 mg/week. Her family had obtained this medication from a pharmacy without a pre- scription. The patient and her family denied receiving any systemic treatment. Sharply demarcated, erythematous, scaly plaques were apparent over the patient’s entire body. A few pustules were observed on these plaques. In addition, the patient exhibited livid striae on her legs, arms, and trunk, a moon face, a buffalo hump, and trun- cal obesity (Figs. 1 and 2). Her serum cortisol level was lower and her adrenocorticotropic hormone level higher than the normal ranges. Bone densitometry values were significantly low for her age and gender group; the patient’s bone age was 12 years and six months. Accord- ing to these clinical and laboratory findings, the patient was diagnosed with iatrogenic Cushing’s syndrome caused by the prolonged use of a high-potency topical corticosteroid (TC). The topical steroid was ceased, and methotrexate (7.5 mg/week) and hydrocortisone acetate (8 mg/m 2 /d) were initiated in order to prevent adrenal insufficiency. Although new pustules and annular ery- thematous, scaly plaques appeared on her trunk and extremities in the first days of the treatment, pustular lesions resolved completely within two weeks. Topical corticosteroids are often used for their healing effects in the treatment of many skin diseases. Many fac- tors affect the occurrence of the side effects of corticoste- roids, including the pharmacokinetic properties of the corticosteroid, characteristics of the host metabolism, the timing and frequency of dosing, the duration of treatment, Figure 1 Livid striae and erythematous, scaly plaques are apparent on the patient’s legs International Journal of Dermatology 2014, 53, e1–e79 ª 2013 The International Society of Dermatology Correspondence e20