症例は74歳男性，2型糖尿病および糖尿病性腎症腎不全期のため通院。2014年5月より感作性皮膚炎と診断されステロイド外用薬投与開始。血糖管理は良好であった。2015年2月維持透析療法開始。皮膚症状の増悪を認め，ステロイド外用薬を増量されると同時期より血糖管理の悪化を認めた。同年5月強化インスリン療法開始により血糖管理は良好となった。本症例では皮膚疾患の増悪に伴うステロイド外用薬増量および透析導入に伴う皮膚バリア機構の破綻促進に伴うステロイド吸収の助長が血糖管理悪化の原因と推察される。ステロイド外用薬は一般的に局所作用に留まり全身作用をきたすことは非常に稀であるため報告する。

   The present patient was a 74-year-old man who had been visiting our hospital for treatment of type 2 diabetes and renal failure. In May 2014, he was diagnosed with sensitization dermatitis for which topical steroid application was initiated. His blood glucose control had remained good. Maintenance dialysis therapy was initiated in February 2015. Skin symptoms worsened, and the topical steroid dose was increased. Around that time, his blood glucose control got worsened, and intensive insulin therapy was initiated in May 2015. His blood glucose control was improved. In this case, deterioration in blood glucose control was presumed to be due to percutaneous steroid absorption facilitated by overdose of topical steroid for the skin condition as well as disruption of the skin barrier owing to chronic renal failure. In general, topical steroids only act locally; thus, they hardly cause systemic effects on laboratory tests. So we reported here a very rare case.