RESUMEN
Glucocorticoids are used for the treatment of many diseases, such as inflammatory, allergic, autoimmune, and neoplastic diseases. They can be used in the form of topical, oral, inhalable, rectal, and intra-articular agents. Many topical steroid-related iatrogenic Cushing's syndrome cases affecting especially children have been reported in the literature. Topical steroid-related Cushing's syndrome is rarely seen in adults. In this report, we present the case of a 32-year-old male patient with iatrogenic Cushing's syndrome related to long-term clobetasol propionate treatment for psoriasis. In the context of such treatment, the glucocorticoid withdrawal problem has to be overcome. At present there is no consensus on steroid withdrawal. Patients on long-term glucocorticoid treatment must be evaluated for potential adverse effects and withdrawal symptoms by their physician and their endocrinologist.
RESUMEN
Neuropathological and molecular basis of pruritus has not been clarified and the presence of certain specific neural circuits have been proposed. Our aim in this study was to evaluate the role of Aδ fibers in the neural circuits of pruritus by cutaneous silent period (CSP). Thirty-six patients with chronic idiopathic generalized pruritus and 32 healthy controls were enrolled in the study. CSP and nerve conduction studies of upper and lower extremities were performed in both groups. Latencies of CSP in the upper and lower extremities were observed to be prolonged in the patient group compared with the controls while durations were shortened (all P < 0.001). However, these values were not correlated with sex, age, duration or severity of the disease (all P > 0.05). Our data suggest that pruritus may be developed by a nerve conduction abnormality in the afferent fibers of Aδ, or cortical hypersensitivity, abnormality of the cortical inhibitory mechanisms or lack of inhibition in the intermediate spinal inhibitory neurons generating CSP. This topic needs to be evaluated thoroughly in larger series with more detailed studies.