From the Guidelines
Cortisol rash, also known as steroid-induced dermatitis or steroid rash, typically presents as red, itchy, and inflamed skin, with common signs including redness, small bumps, skin thinning, and increased visibility of blood vessels, as noted in patients treated with ketoconazole 1.
Signs and Symptoms
The signs and symptoms of cortisol rash can vary, but common features include:
- Redness (erythema)
- Small bumps or papules
- Skin thinning
- Increased visibility of blood vessels
- Burning or stinging sensation
- Acne-like appearance with pustules, particularly on the face, chest, and back
- Stretch marks (striae) and increased hair growth or hyperpigmentation with prolonged steroid use
Treatment and Management
Treatment typically involves gradually discontinuing the steroid under medical supervision, rather than stopping abruptly, and using mild, fragrance-free moisturizers to manage symptoms 1.
- Avoiding irritants like harsh soaps
- Using antihistamines for itching or alternative anti-inflammatory medications for severe cases
- Monitoring liver function tests (LFTs) in patients treated with ketoconazole, due to the risk of hepatotoxicity 1
Medical Therapies
Medical therapies, such as metyrapone or ketoconazole, can be effective in reducing cortisol levels, but have a limited role in long-term treatment due to adverse effects 1.
- Metyrapone and ketoconazole can be prescribed by experienced clinical teams with careful titration
- Common adverse effects of metyrapone include hirsutism, dizziness, arthralgia, fatigue, hypokalaemia, and nausea
- Ketoconazole is associated with hepatotoxicity and liver function should be monitored on therapy
From the Research
Signs and Symptoms of Cortisol Rash
There are no direct research papers to assist in answering this question. However, the provided studies discuss the management and treatment of Cushing's syndrome, a condition characterized by excessive adrenocortical steroid production, which can lead to elevated cortisol levels.
Related Information
- The studies 2, 3, 4, 5, 6 focus on the pharmacological management of Cushing's syndrome, including the use of steroidogenesis enzyme inhibitors such as metyrapone, ketoconazole, and etomidate.
- These inhibitors can help control hypercortisolemia, but their use is often accompanied by serious adverse side effects, which can limit dosing and result in treatment failures.
- The studies do not specifically mention cortisol rash as a sign or symptom of Cushing's syndrome or elevated cortisol levels.
- However, it is known that Cushing's syndrome can cause a range of symptoms, including weight gain, hypertension, glucose intolerance, and skin changes, such as thinning skin, easy bruising, and poor wound healing 5.
- Some of the studies mention adverse events associated with the use of steroidogenesis enzyme inhibitors, such as gastrointestinal upset, dizziness, and changes in liver function tests 3, 6.
Key Points
- Cushing's syndrome is a condition characterized by excessive adrenocortical steroid production, leading to elevated cortisol levels.
- Steroidogenesis enzyme inhibitors, such as metyrapone, ketoconazole, and etomidate, can help control hypercortisolemia.
- These inhibitors can have serious adverse side effects, which can limit their use.
- Cushing's syndrome can cause a range of symptoms, including weight gain, hypertension, and skin changes.
- There is no direct information available on cortisol rash as a sign or symptom of Cushing's syndrome or elevated cortisol levels.