Capewell S, Reynolds S, Shuttleworth D, Edwards C, Finlay A Y
Department of Tuberculosis and Chest Diseases, University of Wales College of Medicine, Llandough Hospital, Cardiff, South Glamorgan.
BMJ. 1990 Jun 16;300(6739):1548-51. doi: 10.1136/bmj.300.6739.1548.
To assess the effect of high dose inhaled corticosteroids on skin.
Cross sectional study of patients receiving treatment for chest diseases.
Outpatient chest clinic in a teaching hospital.
68 Patients divided into four groups of similar age--namely, 15 receiving long term oral prednisolone, 21 receiving high dose inhaled corticosteroids, 15 receiving low dose inhaled corticosteroids, and 17 controls.
Skin thickness at three sites measured by A scan ultrasound and clinical assessment of purpura.
Compared with controls patients in both the oral prednisolone treated group and the high dose inhaled corticosteroid treated group had significantly thinner skin at all three sites (group median thicknesses: prednisolone treated group 28-33% less than controls; high dose inhaled corticosteroid treated group 15-19% less than controls). Differences in skin thicknesses between the low dose inhaled corticosteroid treated group and the controls were trivial. The prevalence of purpura was significantly greater in patients receiving oral prednisolone (12/15 patients) and high dose inhaled corticosteroids (10/21) than in controls (2/17).
Skin thinning and purpura represent further evidence of systemic effects of high dose inhaled corticosteroids.
评估高剂量吸入性糖皮质激素对皮肤的影响。
对接受胸部疾病治疗的患者进行横断面研究。
一家教学医院的门诊胸部诊所。
68名患者被分为年龄相近的四组，即15名接受长期口服泼尼松龙治疗的患者、21名接受高剂量吸入性糖皮质激素治疗的患者、15名接受低剂量吸入性糖皮质激素治疗的患者以及17名对照组患者。
通过A型超声测量三个部位的皮肤厚度以及对紫癜进行临床评估。
与对照组相比，口服泼尼松龙治疗组和高剂量吸入性糖皮质激素治疗组的患者在所有三个部位的皮肤均明显更薄（组中位数厚度：泼尼松龙治疗组比对照组薄28 - 33%；高剂量吸入性糖皮质激素治疗组比对照组薄15 - 19%）。低剂量吸入性糖皮质激素治疗组与对照组之间的皮肤厚度差异微不足道。接受口服泼尼松龙治疗的患者（12/15例）和高剂量吸入性糖皮质激素治疗的患者（10/21例）中紫癜的患病率明显高于对照组（2/17例）。
皮肤变薄和紫癜是高剂量吸入性糖皮质激素产生全身效应的进一步证据。
