The relevance of these findings to potential cutaneous effects of other commonly used ICSs might be inferred from published data concerning the equi-systemic effects (ie, microgram dose producing equal systemic cortisol suppression) of six inhaled corticosteroid preparations. According to the latter report, TAA produces a systemic effect (10% cortisol suppression) that is equivalent to 1.43 times the microgram dose of beclomethasone chlorofluorocarbon (CFC). By comparison, flunisolide CFC, fluticasone dry powder inhaler, budesonide dry powder inhaler, and fluticasone metered-dose inhaler CFC produce systemic effects equivalent to that of 1.71, 0.81, 0.50, and 0.20 times the microgram dose of beclometha-sone CFC, respectively. comments
Previous cross-sectional studies in relatively small numbers of patients with respiratory disease (mainly asthma) using ICSs have reported a higher prevalence of easy bruising (range, 47 to 71%) in the ICS users compared to control subjects (range, 12 to 32%), with the prevalence being higher when based on questionnaire responses than on direct examination. In one study, skin thickness was assessed by pulsed ultrasound and was found to be significantly less than that of control subjects in patients treated with high-dose ICSs (ie, a 1,000 beclomethasone) but not in those treated with low doses (ie, < 800 ^g beclomethasone). In these studies, the frequency of easy bruising was particularly increased in those receiving higher daily doses of ICSs (ie, a 1,000 to 1,388 ^g beclomethasone dipropionate) and in older individuals, while the influence of gender was inconsistent. Moreover, one of these studies indicated that adrenal function was significantly lower in those reporting bruising, and, while abnormally reduced adrenal function occurred less commonly (14%) than reported skin bruising (71%), adrenal impairment was found only in those who reported bruising. These findings suggest that skin bruising, a readily visible side effect, may be a more sensitive marker of the systemic toxicity of ICSs than reduced adrenal function.