SKIN BRUISING IN ASTHMATIC SUBJECTS TREATED WITH HIGH-DOSES OF INHALED STEROIDS - FREQUENCY AND ASSOCIATION WITH ADRENAL-FUNCTION

High doses of inhaled corticosteroids (ICS) (budesonide and beclometha sone greater than or equal to 800 mu g . day(-1)) are commonly used in the treatment of asthma, Some investigators have presented evidence f or cutaneous effects (bruising), which suggests systemic absorption. T his study aimed to assess the prevalence of skin bruising, relate the occurrence of skin bruising to adrenocortical function, and determine the risk factors for skin bruising. One hundred adult asthmatic subjec ts taking high doses (800-2,000 mu g . day(-1)) of ICS for 3 months or more were recruited in an asthma clinic, and 100 control subjects pai red for sex and age were recruited from an ophthalmology out-patient c linic A detailed questionnaire on asthma, general habits and cutaneous lesions was administered, A cutaneous examination was performed, Urin e cortisol levels were assessed on two consecutive days. Blood cortiso l level and the response to Cortrosyn injection (60 min test) were eva luated. One hundred adult asthmatics (66 females and 34 males), 73 on beclomethasone and 27 on budesonide, were included. The prevalence of skin bruising was 71% based on the questionnaire (32% in controls) and 48% (39 out of 81 subjects) based on direct examination of the skin. We found a satisfactory association between the response to questionna ire and examination of the skin. Adrenocortical function testing showe d that a minority of subjects (14 with at least one abnormal test) had lower urinary or blood cortisol levels. These low cortisol levels occ urred in subjects who reported skin bruising. By multiple logistic reg ression, being a female (odds ratio (OR)=20; 95% confidence interval ( 95% CI)=13-33) and taking ICS for asthma (OR=12; 95% CI=8-18) were sig nificantly (t=5.4) related to the likelihood of developing skin bruisi ng. In addition, among the asthmatic subjects, being older (OR=1.6; 95 % CI=1.1-2.4/10 yrs interval) (t=23) and being a female (OR=22; 95% CI =7-75) (t=5.0) influenced the occurrence of skin bruising as documente d by questionnaire. In asthmatic subjects, taking high doses of ICS is associated with: 1) increased occurrence of skin bruising by comparis on with controls, particularly in older subjects; and 2) a generally n ormal adrenocortical function, although this function is significantly lower in subjects reporting skin bruising.