Cushing Syndrome from Percutaneous Absorption of 1% Hydrocortisone Ointment in Netherton Syndrome

An 11-year-old boy with Netherton syndrome (NS) developed Cushing syndrome after using 1% hydrocortisone ointment extensively over his entire body for more than a year. NS is characterized by defective skin barrier function, leading to increased absorption of topical medications. Despite being a low-potency steroid, the hydrocortisone ointment caused significant systemic side effects due to the compromised skin barrier in NS. This case highlighted the need for cautious use of even low-potency steroids in patients with NS and other conditions with reduced skin barrier function, emphasizing the importance of monitoring and educating patients and caregivers on safe usage.