Expert Answers: Steroid Bruising

Have you ever experienced bruising, yet have no idea where the bruises came from? Read on for information from our expert respiratory therapists about steroid bruising and COPD. Our experts answered the following question from the community:

Long-term steroid use and bruising

Response from John

Corticosteroids mimic the response of cortisol that is released by the adrenal gland. The desired response is that it reduces inflammation, like airway inflammation, making breathing easier.

One unwanted side effect of long-term use is it can cause thinning of the cells lining vessels under the skin. This can cause them to break easily so that even a simple bump can cause a bruise. This is one of those trade offs that people with lung diseases like COPD have to deal with. Systemic steroids are sometimes needed to get over flare-ups, and some need to take low doses of systemic steroids long-term just to breathe.

Physicians are well aware of this potential side effect, and it's for this reason they try to prescribe them only when necessary, and at the lowest doses possible. While side effects of inhaled steroids are usually minimal, they too can sometimes cause bruising. This is an issue that I deal with, and it's a fair trade-off for the good asthma control that results from taking them. If bruising continues to be a concern of yours, make sure to let your doctor know.

Response from Leon

Bruising and even skin tearing is an issue some people with COPD have experienced. Although inhaled corticosteroids (ICS) can be one of the foundations of treating people with COPD, they are not without their side effects. Easy skin bruising is a well-recognized systemic side effect of ICS therapy, particularly when administered in high doses, and to older individuals as well. In general, older persons have an increased risk of skin bruising due to age-related dermal thinning. Add all this together, and it certainly appears as though people with COPD can be predisposed to bruising and skin tears.

What to do? Since aerosolized steroid medication frequently is a mainstay of the treatment regimen for people with COPD, safety and sensible precautions become of paramount importance to the individual. If you find yourself prone to skin bruising, and even tearing, consult with your physician for suggestions and recommended treatment. Medication is available, and this article, "Tools That Can Help", will provide additional information. As mentioned, skin tears may also be an issue. You may find this article, "What is a Skin Tear?" also proves helpful.

Bruising can be yet another challenge for folks with COPD. The advice is to take whatever precautions you may find helpful, necessary, and successful: long sleeves and/or taking particular care with activities to avoid bumping into things, are a just a few.

Response from Lyn

Corticosteriods are a common medication used to treat symptoms of COPD. They are used to suppress inflammation in the lungs and airways. Unfortunately, one of the common side effects is “thin skin”. Related to that is bruising, skin tearing, and slow wound healing.

You may have noticed that a bruise will appear and you don’t even remember bumping into anything or hitting yourself in that spot. The little capillaries under the skin become fragile and allow for bruising that easily.

In general, the length of time you’ve been on the corticosteroids as well as the dosage has a big effect on how severe these types of side-effects are. There are some precautions you can take that may help. Some people have told me they wear Geri-sleeves to bed or around the house when they’re doing things that may cause inadvertent bruising. It’s just a cotton/spandex sleeve you slip on both arms, usually up to or just above the elbows. They serve to protect the fragile skin of your lower arms. They can be bought in most surgical supply stores or specialty drug stores. Or you can speak to your doctor and he or she may be able to give you a set.

What about you? Do you have experience with steroid bruising? Please share in the comments!