Easy bruising as a side-effect of inhaled corticosteroids

Abstract

We wished to determine the prevalence of easy bruising in patients taking inhaled corticosteroids (ICS) compared with those who do not. Differences in age, dosage and duration of use of ICS between patients who bruised and those who did not were also investigated. Confidential questionnaire surveys were conducted over a 6 month study period amongst patients attending a respiratory out-patient clinic and taking regular ICS, and a control group of patients attending non-respiratory clinics and not taking any form of corticosteroids. Patients with bleeding disorders or taking oral steroids, non-steroidal anti-inflammatory drugs or anticoagulants were excluded from the study. Questionnaires from 202 respiratory patients using ICS (group A) were compared with 204 non-ICS patients (Group B) of similar age and sex distribution. Significantly more patients in Group A reported easy bruising than in group B (47 vs 22%, relative risk 2.18, 95% confidence interval (95% CI) 1.62-2.94), and it was the commonest reported symptom. In Group A, the patients that reported easy bruising tended to be older (61 vs 52 yrs), on higher daily dosages (1,388 vs 1,067 micrograms) and had been taking inhaled corticosteroids for longer (55 vs 43 months) than non-bruisers. Overall, females reported easy bruising more frequently than males in both groups. However, comparing Group A with Group B, males taking ICS had a higher relative risk for bruising than females (males, relative risk 5.80, 95% CI 2.38-14.13; females, relative risk 1.80, 95% CI 1.32-2.44).(ABSTRACT TRUNCATED AT 250 WORDS)

Is long-term treatment with inhaled steroids in adults hazardous?

“…Skin-thinning combined with spontaneous and easy bruising has been reported in conjunction with highdose inha led BDP (25,26]. In this issue of the Journal, MAK et al (27] report on a questionnaire survey of the prevalence and characteristics of easy bruising in patients on inhaled steroids. The authors demonstrate a significantly higher prevalence of easy bruising in respiratory patients taking inhaled steroids compared with non-respiratory patients without topical treatment.…”

Untitled

“…Inhaled medication includes glucocorticoids (Beclomethasone dipropionate, budesonide, and fluticasone propionate), Short-acting beta agonists such as salbutamol, anticholinergic drugs, mast cell stabilizers, leukotriene modifiers (montelukast, pranlukast, and zafirlukast), longacting beta 2 agonists, anti-IgE (Omalizumab), systemic glucocorticoid other therapies include methotrexate, [21] cyclosporine, [22] and gold. [23] Long-term treatment with high doses of inhaled glucocorticoids causes easy bruising, [24] cataracts, [25] adrenal suppression, [26] diminished bone mineral density, [27] and glaucoma in cross-sectional studies. [28] Long-term treatment with oral or parenteral glucocorticoid treatment can cause osteoporosis, arterial hypertension, diabetes, obesity, skin thinning, cutaneous striae, and muscle weakness.…”

Yellowish face mask in a child: A local side-effect of inhaled corticosteroids?

“…Easy bruising is a systemic ICS side effect and can be simply defined as "bruising resulting from a slight knock or without apparent cause." [4] The risk of this adverse reaction is more important among the elderly and increase with daily dosage and duration of treatment. It is probably present in about 50% of patients treated with ICS, presenting as purpuric or ecchymotic lesions occurring on the face, the limbs, or the neck, although neither the true incidence in children nor the dosage and duration of therapy at which it appears are known.…”

“…[1] Easy bruising can also occur in Cushing's disease, bleeding disease, and collagen-related syndromes such as Ehlers-Danlos. [4] Hypertrichosis as a side effect of inhaled steroids has been reported in children. [5] Bruising is probably dependent on collagen synthesis modification.…”