Drs JR HUGHES, EM HIGGINS, and AWP DU VIVIER (Department of Dermatology, King's College Hospital, London SE5 9RS) write: High dose inhaled glucocorticosteroids are known to have systemic effects on the skin. We describe a patient who developed acne while using an inhaled glucocorticosteroid, an association not previously reported. A 75 year old man was referred to our department with a four year history of a papulopustular eruption on his back. This had been diagnosed as acne but had not responded to conventional treatment with topical antibiotics or long term oral minocycline or erythromycin. He had no history of acne or other skin disease.

He had a 13 year history of late onset asthma. Initial treatment with inhaled salbutamol did not control his symptoms and he had needed intermittent courses of oral steroids for the first eight years after diagnosis. These were then stopped and replaced by oral aminophylline 450 mg twice daily, beclomethasone dipropionate 500 mg twice daily, and salbutamol 200, ug four times daily by aerosol inhalation. His asthma was well controlled and he had not taken oral steroids for the past five years.