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Salbutamol inhaler misuse resulting in skin burn
J ALLERGY CLIN IMMUNOL VOLUME 127, NUMBER 1
Salbutamol inhaler misuse resulting in skin burn To the Editor: Educational intervention is a key point in the management of asthma. Patients need to have proper understanding of selfmanagement strategies and possible side and adverse effects of drugs they are using. Adverse effects of inhaled bronchodilators and corticosteroids taken in a conventional way are mainly orotracheal, and a few are systemic. We report an unusual adverse dermatologic effect resulting from pressurized salbutamol aerosol misuse. A 13-year-old boy presented with a well-delineated purplish skin injury and blister on the anterior aspect of his left midforearm. History revealed that a schoolmate with known asthma actuated his own salbutamol canister (Ventoline; GlaxoSmithKline, Marly-le-Roi, France) against the patient’s skin about 10
CORRESPONDENCE 295
times in short sequence. A blister developed within 2 days, broke at day 3 (picture) and healed over the ensuing 2 weeks. Five other schoolmates exposed to the same canister had similar burns. The boy with asthma was firmly asked to give up this ‘‘recreational’’ activity with the canister. Mechanisms for skin injury may include (1) sudden decompression and evaporation of aerosol leading to cold-induced skin damage, (2) physical injury from impact of high-velocity gas (here hydrofluoroalkane-134a) against the skin, and (3) chemical injury. A few similar reports appeared in the literature.1-4 Skin injury may appear in the form of isolated or multiple spots on a distinct area of the body surface.4 Deliberate aerosol-induced skin injury was reported in the context of Munchausen syndrome.1 Of note, the exact shape of canister mouthpiece exhaust (Fig 1) is a clue to recognition of pressurized aerosol-induced skin injury. Education and preventative measures are indicated, especially in teenagers, to avoid this form of injury, particularly considering possible disfiguring facial lesions or eye damage. We thank Jules Bonniaud for his contribution to this work. Philippe Bonniaud, MD, PhD Marjolaine Georges, MD Marion Blanc-Caille, MD Evelyne Collet, MD Philippe Camus, MD From the University of Burgundy and Centre Hospitalier Universitaire du Bocage, Service de Pneumologie et Reanimation Respiratoire; and Service de dermatologie, Institut National de la Sante et de la Recherche Medicale, UMR 866, Dijon, France. E-mail: [email protected]. Disclosure of potential conflict of interest: The authors have declared that they have no conflict of interest. Editor’s note: There is no accompanying reply to this correspondence.
FIG 1. Skin burn with a broken blister 3 days after close salbutamol release from a salbutamol canister applied against the left mid-forearm skin surface.
REFERENCES 1. Akhtar S, Majumder S. An unusual self inflicted burn in an asthmatic patient. Burns 2003;29:191-2. 2. Arun B, Jacob J, Byrne JP. An uncommon burn. Br J Dermatol 2009;160:197. 3. Connolly M, Kennedy CT. Inhaler-induced pigmentary changes in a 14-year-old girl. Pediatr Dermatol 2007;24:499-500. 4. Patel R, Potter SJ. Ten puffs too many. Arch Dis Child 2004;89:1129. doi:10.1016/j.jaci.2010.09.042
Salbutamol inhaler misuse resulting in skin burn To the Editor: Educational intervention is a key point in the management of asthma. Patients need to have proper understanding of selfmanagement strategies and possible side and adverse effects of drugs they are using. Adverse effects of inhaled bronchodilators and corticosteroids taken in a conventional way are mainly orotracheal, and a few are systemic. We report an unusual adverse dermatologic effect resulting from pressurized salbutamol aerosol misuse. A 13-year-old boy presented with a well-delineated purplish skin injury and blister on the anterior aspect of his left midforearm. History revealed that a schoolmate with known asthma actuated his own salbutamol canister (Ventoline; GlaxoSmithKline, Marly-le-Roi, France) against the patient’s skin about 10
CORRESPONDENCE 295
times in short sequence. A blister developed within 2 days, broke at day 3 (picture) and healed over the ensuing 2 weeks. Five other schoolmates exposed to the same canister had similar burns. The boy with asthma was firmly asked to give up this ‘‘recreational’’ activity with the canister. Mechanisms for skin injury may include (1) sudden decompression and evaporation of aerosol leading to cold-induced skin damage, (2) physical injury from impact of high-velocity gas (here hydrofluoroalkane-134a) against the skin, and (3) chemical injury. A few similar reports appeared in the literature.1-4 Skin injury may appear in the form of isolated or multiple spots on a distinct area of the body surface.4 Deliberate aerosol-induced skin injury was reported in the context of Munchausen syndrome.1 Of note, the exact shape of canister mouthpiece exhaust (Fig 1) is a clue to recognition of pressurized aerosol-induced skin injury. Education and preventative measures are indicated, especially in teenagers, to avoid this form of injury, particularly considering possible disfiguring facial lesions or eye damage. We thank Jules Bonniaud for his contribution to this work. Philippe Bonniaud, MD, PhD Marjolaine Georges, MD Marion Blanc-Caille, MD Evelyne Collet, MD Philippe Camus, MD From the University of Burgundy and Centre Hospitalier Universitaire du Bocage, Service de Pneumologie et Reanimation Respiratoire; and Service de dermatologie, Institut National de la Sante et de la Recherche Medicale, UMR 866, Dijon, France. E-mail: [email protected]. Disclosure of potential conflict of interest: The authors have declared that they have no conflict of interest. Editor’s note: There is no accompanying reply to this correspondence.
FIG 1. Skin burn with a broken blister 3 days after close salbutamol release from a salbutamol canister applied against the left mid-forearm skin surface.
REFERENCES 1. Akhtar S, Majumder S. An unusual self inflicted burn in an asthmatic patient. Burns 2003;29:191-2. 2. Arun B, Jacob J, Byrne JP. An uncommon burn. Br J Dermatol 2009;160:197. 3. Connolly M, Kennedy CT. Inhaler-induced pigmentary changes in a 14-year-old girl. Pediatr Dermatol 2007;24:499-500. 4. Patel R, Potter SJ. Ten puffs too many. Arch Dis Child 2004;89:1129. doi:10.1016/j.jaci.2010.09.042