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Change of Oral to Topical Corticosteroid Therapy Exacerbated Glucose Tolerance in a Patient with Plaque Psoriasis

Yui Hongo, Kenji Ashida, Kenji Ohe, Munechika Enjoji, Miyuki Yamaguchi, Tsuyoshi Kurata, Akiko Emoto, Hiroko Yamanouchi, Satoko Takagi, Hitoe Mori, Nozomi Kawata, Yoshio Hisata, Yuta Sakanishi, Kenichi Izumi, Takashi Sugioka, Keizo Anzai

(Department of Internal Medicine, Saga University Hospital, Saga City, Saga, Japan)

Am J Case Rep 2017; 18:1198-1203

DOI: 10.12659/AJCR.905470


BACKGROUND: Psoriasis is known as the most frequent disease treated by long-term topical steroids. It is also known that patients with thick, chronic plaques require the highest potency topical steroids. However, the treatment is limited to up to four weeks due to risk of systemic absorption.
CASE REPORT: An 80-year-old man was diagnosed with type 2 diabetes 16 years before, and was being administered insulin combined with alpha glucosidase inhibitor. He was diagnosed with plaque psoriasis and his oral steroid treatment was switched to topical steroid treatment due to lack of improvement and poorly controlled blood glucose level. The hypoglycemic events improved after the psoriatic lesions improved.
CONCLUSIONS: Control of blood glucose level is difficult at the very beginning of topical steroid treatment for psoriasis especially if a patient is receiving insulin treatment. Intense monitoring of blood glucose level during initiation of topical steroid treatment is necessary to prevent unfavorable complications.

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