Cutaneous adverse effects of inhaled steroids.

(1) Oral steroids can damage the skin. Cutaneous thinning and bruising have also been reported with inhaled steroids. (2) A randomised double-blind placebo-controlled trial of inhaled triamcinolone in chronic obstructive pulmonary disease provides useful data on the frequency of such effects. (3) The frequency of bruising was 11.2% with the steroid and 3.7% with placebo, while delayed wound healing occurred in respectively 2.4% and 0.5% of patients. These cutaneous adverse effects were dose-dependent and increased with age. (4) The inhaled route does not prevent steroid adverse effects occurring at a distance from the airways. This is one more reason for using the minimal effective dose of inhaled steroids, especially in older patients.