Purpura and dermal thinning associated with high dose inhaled corticosteroids.

Capewell, Simon; Reynolds, Sarah; Shuttleworth, D.; Edwards, C. R. W.; Finlay, Andrew Y.

doi:10.1136/bmj.300.6739.1548

Cited by 177 publications

(85 citation statements)

References 22 publications

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“…In that study, a slight dermal thinning on the forearm was observed after treatment with daily budesonide doses of 800 -1600 g. The skin thickness was, however, normalized after 1-2 y of continuous therapy suggesting no dose relationship and only a temporary effect on the skin. Advanced dermal thinning and purpura are well known side-effects of treatment with oral corticosteroids and also with high-dose ICS (2)(3)(4). In an observational study in 157 children treated for 3-6 y with an average daily dose of ϳ500 g of budesonide, no skin bruising was reported in comparison with 111 control children (22).…”

Section: Discussionmentioning

confidence: 99%

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Skin Thickness in Children Treated With Daily or Periodical Inhaled Budesonide for Mild Persistent Asthma. The Helsinki Early Intervention Childhood Asthma Study

et al. 2010

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ABSTRACT:In adults, asthma treatment with high doses of inhaled corticosteroids has resulted in dermal thinning. The aim of this study was to investigate the skin thickness in children with asthma during budesonide treatment. In a double-blind study, 113 children, 5-10 y old, with persistent asthma received budesonide 400 g twice daily for 1 mo and thereafter 200 g twice daily for 5 mo. Thereafter, 56 children received 100 g twice daily for 1 y, whereas 57 other children used budesonide periodically for exacerbations. An additional 54 children were treated with disodium cromoglycate (DSCG) for 18 mo. Skin thickness was measured on each forearm before and after treatment for 6, 12, and 18 mo using a 20-MHz high-resolution ultrasonic device. The initial 6-mo budesonide treatment resulted in a greater reduction in mean skin thickness in the forearms compared with DSCG (right: Ϫ35.9 versus Ϫ5.9 m; p ϭ 0.004; left: Ϫ30.6 versus Ϫ7.3 m; p ϭ 0.03). At month 18, the inter-group differences were no longer significant. Budesonide inhalations in daily doses of 400 -800 g in prepubertal children with newly detected asthma may cause minor dermal thinning. The changes were reversible during low dose or periodic treatment with budesonide. (Pediatr Res 67: 221-225, 2010)

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Section: Discussionmentioning

confidence: 99%

“…However, ICS may have systemic effects. High doses of ICS may result in purpura and dermal thinning (2,3). In older subjects, e.g.…”

mentioning

confidence: 99%

Skin Thickness in Children Treated With Daily or Periodical Inhaled Budesonide for Mild Persistent Asthma. The Helsinki Early Intervention Childhood Asthma Study

et al. 2010

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“…Skin bruising and thinning have been documented as side effects of ICS use [134][135][136], especially in patients receiving high-dose ICS [134]. There is a greater risk of easy bruising in elderly patients [135][136][137][138][139] and in women [135].…”

Section: Skin Thinning and Bruisingmentioning

confidence: 99%

A Review on the Safety and Efficacy of Inhaled Corticosteroids in the Management of Asthma

D’Urzo

2017

Pulm Ther

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Asthma is a chronic inflammatory disease characterized by symptoms of cough, dyspnea, chest tightness, and wheeze. Inhaled corticosteroids (ICS) have been recommended as initial therapy in the treatment of persistent asthma in all guidelines, as they have been shown to reduce morbidity and mortality. However, high-dose regimens and long-term use of ICS may be associated with a variety of side effects, similar to those observed with systemic corticosteroid therapy. These side effects include impaired growth in children, osteoporosis, fractures, glaucoma, cataracts, and skin thinning. The current recommendations on ICS use in asthma management will be reviewed in this article with a view to highlight treatment strategies that strike an optimal balance between safety and efficacy.

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“…118,119 One study showed that skin thickness measured by an ultrasound scan was significantly reduced by 15-19% in subjects on BDP 1000-2250 µg/day compared with controls. 118 In addition, the prevalence of bruising was significantly higher at 48% in this patient population compared with 12% in the control population. 118 The results of a further survey also indicated that easy bruising was the commonest reported symptom, with the use of ICS occurring in almost half of the individuals.…”

Section: Adverse Eventsmentioning

confidence: 99%

Systematic review and economic analysis of the comparative effectiveness of different inhaled corticosteroids and their usage with long-acting beta2 agonists for the treatment of chronic asthma in children under the age of 12 years

Main¹,

Shepherd²,

Anderson³

et al. 2008

Health Technol Assess

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Purpura and dermal thinning associated with high dose inhaled corticosteroids.

Cited by 177 publications

References 22 publications

Skin Thickness in Children Treated With Daily or Periodical Inhaled Budesonide for Mild Persistent Asthma. The Helsinki Early Intervention Childhood Asthma Study

Skin Thickness in Children Treated With Daily or Periodical Inhaled Budesonide for Mild Persistent Asthma. The Helsinki Early Intervention Childhood Asthma Study

A Review on the Safety and Efficacy of Inhaled Corticosteroids in the Management of Asthma

Systematic review and economic analysis of the comparative effectiveness of different inhaled corticosteroids and their usage with long-acting beta2 agonists for the treatment of chronic asthma in children under the age of 12 years

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