Bruise Easy? Your Inhaled Steroid Might Be To Blame
Last updated: March 2023
I am not particularly graceful, but I'm not also particularly clumsy. (Okay maybe I am, but rarely to the point that I trip and actually fall often, or that I've ever broken a bone.) I bump stuff often enough, sure, but not nearly hard enough to warrant the quantity and harshness of the bruises frequently popping up on my lower legs and arms that I have little explanation for.
My grandma was recently commenting (for the gazillionth time) about the collection of bruises on my leg asking "Where'd you get those bruises?"
Are inhaled corticosteroids causing my bruising?
Finally, after nearly 8 years on inhaled steroids, I considered this possibility. While the side effect of bruising is pretty well known with oral (systemic) corticosteroids like prednisone, what about inhaled ones? Sure enough, there is research from as far back as 1992 that links easy bruising, especially in the lower legs and forearms to using higher doses of inhaled corticosteroids.1,2
Mystery solved for me. Well, at least I have an explanation for why I'm always so bruised despite not playing contact sports or anything. (I mean, if I were playing goalball with the guys I coach rather than just coaching, that would be an explanation because that ball is hard.)
It turns out, that it's been long noted that increased skin bruising, or "skin thinning", is a side effect of higher doses of inhaled corticosteroids (over 1000 micrograms [mcg] daily).1 Why I haven't made this connection before, of course, I'm unsure, but that's why I'm sharing with you, Asthma.net readers! Yes, bruising can be a symptom of other medical issues, but, if you've got nothing else weird going on and your bruises look fairly normal, it could just be your inhaled corticosteroids.1
Contributing to skin thinning
A slightly more recent article (slightly) from 1996 notes that in doses over 1500 mcg increased "skin fragility" may occur, including bruising--in the 1992 study, participants reported easy bruising as their most common side effect.1,2 This is more likely to occur in older patients, those on higher doses of inhaled steroids, and women.1 They also link the bruising with "chronic UV exposure" areas of the body--specifically, lower legs and forearms.1
If inhaled steroids are supposed to have fewer systemic (throughout the body) side effects than oral ones, why does it affect the skin (and other parts of the body, as in glaucoma, another well-known side effect of asthma meds which affects the eye, or eyes)?1 Well, it's been found that no matter what inhaler device you're using, some of the medicine you inhale will invariably enter your stomach. Between this and transfer via the lungs into the bloodstream, systemic side effects do occur from inhaled steroids--but they are still safer than systemic ones.3
Essentially, the capillaries (which connect veins and arteries throughout your body) are less resistant to trauma--or bumps--and thus a small amount of blood pools under the skin where these capillaries "leak" blood under the skin.4 As the lower arms and lower legs are more prone to bumps--simply by hazard of location!--and the blood vessels are less protected than in the upper legs and arms, this causes a perfect storm for easy bruising for some of us receiving inhaled corticosteroid treatments for asthma.4
What should I do about the bruising?
What can be done to maybe ease your easy bruising? If you're really troubled, chat with your doctor to make sure that everything else checks out okay. Otherwise, though, regularly using moisturizer on areas that bruise easy--for me, my legs--can help protect the skin and perhaps toughen it up a bit.1 Protecting easily affected areas from the sun through keeping covered with clothing, or application of sunscreen 1 may help (this could explain my less prevalent bruises in winter when I've got jeans on to protect my legs instead of just shorts, and the change in sun exposure.
I'm going to personally try the moisturizer trick for a while and see how things go. Does anybody else experience easy bruising due to your corticosteroids? Are you sick of always getting asked about it (and brush it off as clumsiness even if you don't really feel that clumsy?! Because that's my boat, and while shaking it off wasn't too troubling for me, I'm happy to have an answer now!
How often do you experience a shortage in your asthma medication?