Unilateral Osteonecrosis of the Femoral Head in a Patient with Atopic Dermatitis Due to Uncontrolled Topical Steroid Treatment, a Case Report
<b>Background and clinical significance:</b> Osteonecrosis of the femoral head (ONFH) is a disease of the epiphysis caused by the death of osteocytes and osteoblasts, resulting in debilitating pain. ONFH can be traumatic or nontraumatic, with prolonged glucocorticoid use being the leadin...
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2025-05-01
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| author | David Glavaš Weinberger Lena Kotrulja Snježana Ramić Patricija Sesar Slaven Babić |
| author_facet | David Glavaš Weinberger Lena Kotrulja Snježana Ramić Patricija Sesar Slaven Babić |
| author_sort | David Glavaš Weinberger |
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| description | <b>Background and clinical significance:</b> Osteonecrosis of the femoral head (ONFH) is a disease of the epiphysis caused by the death of osteocytes and osteoblasts, resulting in debilitating pain. ONFH can be traumatic or nontraumatic, with prolonged glucocorticoid use being the leading cause of nontraumatic ONFH. Atopic dermatitis (AD) is a chronic inflammatory skin condition typically treated with topical corticosteroids. ONFH following topical corticosteroid treatment is exceedingly rare, with limited documentation in the literature. We present a case of an under-recognized complication of prolonged topical corticosteroid treatment. <b>Case presentation:</b> We report a case of a 29-year-old Caucasian male patient with sharp right hip pain. Plain radiographs, a CT scan, and an MRI indicated Ficat and Arlet stage 3 ONFH. The patient reported the prolonged uncontrolled use of topical mometasone furoate for five years due to AD. Following the diagnosis, topical corticosteroids were discontinued, and the treatment was shifted to tacrolimus and, subsequently, to oral methotrexate with folic acid. The patient underwent a total hip arthroplasty in June 2022. Given his young age and poor response to previous treatments, he was transitioned to upadacitinib, which led to significant improvement without skin flare-ups or postoperative hip pain. <b>Conclusions:</b> This case highlights the rare, but serious, risk of ONFH associated with long-term topical corticosteroid use. It underscores the importance of monitoring systemic side effects in dermatological therapies and educating patients on proper corticosteroid use. Alternative treatments, such as upadacitinib, should be considered in young male patients to prevent severe complications. |
| format | Article |
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| institution | Kabale University |
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| language | English |
| publishDate | 2025-05-01 |
| publisher | MDPI AG |
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| series | Reports |
| spelling | doaj-art-0302cab2fe7a4639ae03bc73b7ab33852025-08-20T03:27:42ZengMDPI AGReports2571-841X2025-05-01826510.3390/reports8020065Unilateral Osteonecrosis of the Femoral Head in a Patient with Atopic Dermatitis Due to Uncontrolled Topical Steroid Treatment, a Case ReportDavid Glavaš Weinberger0Lena Kotrulja1Snježana Ramić2Patricija Sesar3Slaven Babić4Traumatology Department, Sestre Milosrdnice University Hospital Center, 10000 Zagreb, CroatiaDermaPlus Clinic, 10000 Zagreb, CroatiaPathology and Cytology Department “Ljudevit Jurak”, Sestre Milosrdnice University Hospital Center, 10000 Zagreb, CroatiaPathology and Cytology Department “Ljudevit Jurak”, Sestre Milosrdnice University Hospital Center, 10000 Zagreb, CroatiaTraumatology Department, Sestre Milosrdnice University Hospital Center, 10000 Zagreb, Croatia<b>Background and clinical significance:</b> Osteonecrosis of the femoral head (ONFH) is a disease of the epiphysis caused by the death of osteocytes and osteoblasts, resulting in debilitating pain. ONFH can be traumatic or nontraumatic, with prolonged glucocorticoid use being the leading cause of nontraumatic ONFH. Atopic dermatitis (AD) is a chronic inflammatory skin condition typically treated with topical corticosteroids. ONFH following topical corticosteroid treatment is exceedingly rare, with limited documentation in the literature. We present a case of an under-recognized complication of prolonged topical corticosteroid treatment. <b>Case presentation:</b> We report a case of a 29-year-old Caucasian male patient with sharp right hip pain. Plain radiographs, a CT scan, and an MRI indicated Ficat and Arlet stage 3 ONFH. The patient reported the prolonged uncontrolled use of topical mometasone furoate for five years due to AD. Following the diagnosis, topical corticosteroids were discontinued, and the treatment was shifted to tacrolimus and, subsequently, to oral methotrexate with folic acid. The patient underwent a total hip arthroplasty in June 2022. Given his young age and poor response to previous treatments, he was transitioned to upadacitinib, which led to significant improvement without skin flare-ups or postoperative hip pain. <b>Conclusions:</b> This case highlights the rare, but serious, risk of ONFH associated with long-term topical corticosteroid use. It underscores the importance of monitoring systemic side effects in dermatological therapies and educating patients on proper corticosteroid use. Alternative treatments, such as upadacitinib, should be considered in young male patients to prevent severe complications.https://www.mdpi.com/2571-841X/8/2/65femoral head osteonecrosisatopic dermatitistopical corticosteroidsadverse effectssteroid-induced avascular osteonecrosis |
| spellingShingle | David Glavaš Weinberger Lena Kotrulja Snježana Ramić Patricija Sesar Slaven Babić Unilateral Osteonecrosis of the Femoral Head in a Patient with Atopic Dermatitis Due to Uncontrolled Topical Steroid Treatment, a Case Report Reports femoral head osteonecrosis atopic dermatitis topical corticosteroids adverse effects steroid-induced avascular osteonecrosis |
| title | Unilateral Osteonecrosis of the Femoral Head in a Patient with Atopic Dermatitis Due to Uncontrolled Topical Steroid Treatment, a Case Report |
| title_full | Unilateral Osteonecrosis of the Femoral Head in a Patient with Atopic Dermatitis Due to Uncontrolled Topical Steroid Treatment, a Case Report |
| title_fullStr | Unilateral Osteonecrosis of the Femoral Head in a Patient with Atopic Dermatitis Due to Uncontrolled Topical Steroid Treatment, a Case Report |
| title_full_unstemmed | Unilateral Osteonecrosis of the Femoral Head in a Patient with Atopic Dermatitis Due to Uncontrolled Topical Steroid Treatment, a Case Report |
| title_short | Unilateral Osteonecrosis of the Femoral Head in a Patient with Atopic Dermatitis Due to Uncontrolled Topical Steroid Treatment, a Case Report |
| title_sort | unilateral osteonecrosis of the femoral head in a patient with atopic dermatitis due to uncontrolled topical steroid treatment a case report |
| topic | femoral head osteonecrosis atopic dermatitis topical corticosteroids adverse effects steroid-induced avascular osteonecrosis |
| url | https://www.mdpi.com/2571-841X/8/2/65 |
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