Differences in skin lesions of endogenous and exogenous Cushing’s patients

Introduction
Cushing’s syndrome is a rare condition characterized by increased glucocorticoid levels. Dermatologically, it causes a variety of skin conditions such as atrophy, striae, acne, plethora, hypertrichosis, hirsutism, acanthosis nigricans, hyperpigmentation, alopecia, purpura and fragile skin. Although skin lesions of Cushing’s syndrome have been described, exogenous and endogenous types have not been studied in detail.

Aim
To determine differences in possible skin lesions depending on the cause of Cushing’s syndrome.

Material and methods
A total of 35 patients – 16 iatrogenic Cushing’s syndrome patients and 19 endogenous Cushing’s syndrome patients – who were diagnosed in Erciyes University and 15 healthy individuals were included in this study.

Results
There was at least one skin finding in 34 (97.1%) of the patients with Cushing’s syndrome and 9 (60%) in the control group (p = 0.001). Comparison regarding skin findings in patient and control groups revealed that hypertrichosis, hyperpigmentation, and fungal infections were significantly more frequent in the patient group than the control group. Hirsutism was found more frequently in the endogenous group whereas stria, hypertrichosis and fungal infections were more frequent in the exogenous group.

Conclusions
Since Cushing’s syndrome is a rare disease and it is often diagnosed later in life, data on the frequency of skin findings are limited and sparse in the literature. In the comparison of endogenous Cushing’s and exogenous Cushing’s groups, acne, hypertrichosis, and fungal infections were found more frequently in the exogenous Cushing’s group and hirsutism more frequently in the endogenous Cushing’s group.