The degree of cutaneous atrophy is dose related. There are now several reports of skin thinning and purpura in association with long-term inhaled steroids. The authors comment on the confounding factor of some patients having had short courses of systemic steroids. A UK questionnaire-based study found easy bruising to be the most commonly reported symptom in a group of patients using inhaled steroids for asthma. 8 Patients that reported easy bruising tended to be older, on higher daily dosages and have increased duration of use.
Women appear to be more likely to develop skin bruising.
The common sites of bruising are the forearms and lower legs which suggests a possible cumulative effect with chronic ultraviolet exposure. Patients should be encouraged to regularly use moisturisers on their arms and legs, as these may reduce bruising and tearing of the skin from minor trauma. Sun protection of these areas, either from clothing or the application of a sunscreen, should also be recommended. There are several reports of sudden-onset moderately severe acne vulgaris in patients on inhaled steroids. This pattern of acne is classical for patients on systemic steroids.