possible toxicity/cause of cushings from personal clobetasol use

[davidzv]

Our sweet dog Sophie, a spritely 45lb terrier/border mix, has been losing muscle mass drastically within the last year. We took her to the MSPCA in Boston where they performed a wise variety of tests. As of now Cushings hasn't been officially diagnosed, but it hasn't been ruled out either.

As of now she isn't exhibiting any of the other symptoms people describe here, i.e. constant drinking of water, excess urination, pot belly, etc. She still has tremendous energy. It's just the loss of muscle mass that is so troubling. (Especially around the spine.)

My wife is convinced that our dog has developed Cushings from a topical cortisteroid (clobetasol proprianate) I apply for mild plaque psoriasis. (I've been using the medicine on and off for a decade.)

I don't think this is possible because the drug comes in a foam and is instantly absorbed into the skin. It's also applied to areas that are usually covered by clothing, i.e. Sophie isn't licking me on any area where I apply the foam. There's really nothing to "rub off" since the medicine isn't suspended in petroleum or other viscous emollient.

Has anyone ever heard of a dog developing Cushings from personal clobetasol or topical cortisteroid use?

[Squirt's Mom]

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[Squirt's Mom]

Hi and welcome,

Your wife is spot on. ;)

http://www.ncbi.nlm.nih.gov/pubmed/23210698

Abstract


Topical corticosteroids are considered first-line therapy in patients with chronic inflammatory oral mucosal diseases; among them, clobetasol propionate is one of the most widely used in oral medicine. Under physiological conditions, the transmucosal application is characterized by a significantly greater absorption than the skin application. Contrary to many publications about the side effects of topical corticosteroids in dermatology, few studies have investigated the systemic effects due to local application of these drugs on oral mucosa. Although topical steroid therapy for the management of oral diseases is generally associated with local adverse effects (candidiasis, stomatopyrosis, and hypogeusia), these drugs can also lead to systemic side effects, such as suppression of the hypothalamic-pituitary-adrenal axis and Cushing's syndrome. This review reports five cases of systemic adverse effects caused by clobetasol propionate topical treatment.

[labblab]

Wow, that is a really a great question! As we can see from Leslie's link, you may be at risk for adverse steroid reactions yourself. But additionally, depending upon several factors, it may be possible for Sophie to be at risk as well. You've already cited a couple of variables -- how quickly is the active ingredient absorbed into the skin, and is the treated skin uncovered? But as we are now learning, dogs who live with owners who apply topical hormonal replacements/preparations can experience adverse reactions as a result of contact through handling/licking. So I would have to guess that the same could be true of steroidal agents, as well, if dogs are handled next to bare skin to which the product has been applied.

Go to this thread re: "Atypical Cushing's" and scroll down a few replies. You will see recent research linking the development of hormonal abnormalities in dogs living with owners who apply topical hormonal agents.

http://www.k9cushings.com/forum/showthread.php?t=198

Has Sophie had any recent bloodwork (or a urinalysis) performed? Were there any results that were outside of normal range? Any additional info you can supply will be really helpful to us.

Marianne

P.S. I just double-checked and my husband uses your same drug for treatment of a chronic skin condition as well! I thought it sounded familiar! In his case, he is using it in cream and lotion form but like you, generally applies it on areas covered by clothing. However, your post has given us some food for thought around our household, too!!

[Squirt's Mom]

HA! This might be a bit more pertinent to Sophie! :p:o

http://archderm.jamanetwork.com/article.aspx?articleid=554848


However, smaller animals, such as dogs, appear more susceptible to adrenocortical suppression from topically applied corticosteroids.3We describe a dog with iatrogenic Cushing's syndrome that resulted from the dog's systemic and/or percutaneous absorption of a topical glucocorticoid prescribed to treat the owner's psoriasis.

[davidzv]

Wow! Thank you for all of the quick responses and informative links. I'm still uncertain how the application of the steroid would transfer to Sophie though. I will share this with my wife, I am sure she will love telling me "told you so"; however the important thing is we keep her healthy.

I am hoping some of this is reversible...

Again, thank you for the information and to k9cushings.com. I'll keep everyone posted.

Regards,

David

[labblab]

Since you say that Sophie doesn't lick your bare skin, I would think that the only way that she would be exposed is if you touch her or hold her against your bare skin upon which you've spread the gel. So if the treated areas are usually clothed, I'd think any risk of exposure would be minimized.

If her only symptom is muscle wasting, I think you've still got a long ways to go before establishing a Cushing's diagnosis anyway. That's why I'm wondering about any lab abnormalities you've seen for her.

Marianne