BMJ Case Reports 2017; doi:10.1136/bcr-2016-218721

Exogenous Cushing's syndrome due to a Chinese herbalist’s prescription of ointment containing dexamethasone

  1. Marie Jose Walenkamp4
  1. 1 Oncologic Surgery, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
  2. 2 Pediatrics, OLVG West Hospital, Amsterdam, The Netherlands
  3. 3 Pediatrics, Rijnstate Hospital, Arnhem, The Netherlands
  4. 4 Pediatrics, VU University Medical Center, Amsterdam, The Netherlands
  1. Correspondence to Miss Winnie Francien Scholtens, winnie_scholtens{at}
  • Accepted 2 April 2017
  • Published 20 April 2017


Eczema in children is a chronic disabling condition. The impact of this condition on the lives of families is often underestimated by conventional physicians. As a consequence parents may investigate complementary treatment options. Close monitoring by a paediatrician is essential, considering that a variety of adverse effects can occur during the use of complementary treatment. We present a 5-year-old girl with eczema. She visited a Chinese herbalist who prescribed an ointment. The parents noticed that the eczema resolved fast, itching decreased and she was finally sleeping well. However, her behaviour changed and appetite increased. Undetectable levels of serum cortisol were found, which was indicative of exogenous Cushing's syndrome. Analysis of the ointment revealed the presence of dexamethasone. Hydrocortisone substitution and subsequently a reduction schedule were implemented, after which endogenous cortisol production recovered after 4 months. Physicians should be aware that unregistered herbal medicine can contain potent drugs such as glucocorticoids.


  • Contributors VF and WFS wrote the first draft of the paper. IAR and MJW contributed to the design and revised the work critically for intellectual content. The paper has been seen and approved by all authors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Collaborators The authors would like to thank Hans Krabbe and Dennis Poland for help with the diagnostic process.

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