Subcutaneous haemorrhages in rheumatoid patients treated with prednisone.

Numerous reports have recently appeared calling attention to skin haemorrhages in patients receiving prednisone and prednisolone (Black, Yielding, and Bunim, 1957; Denko and Schroeder, 1957; Boland, 1956, 1957; Solem and R0mcke, 1956; Neustadt, McClendon, Olash, and Best, 1956; Kinsell, Michaels, Coehlo, Foreman, and Friskey, 1955; Brown, 1956). The occurrence of these ecchymotic lesions has usually been listed among the other side-effects of therapy with these newer steroid substances. Boland (1956) reported that 24 of seventy patients (34 per cent.) receiving prednisone and prednisolone developed subcutaneous haemorrhages, but the report by Denko and Schroeder (1957) is the only detailed study of this toxic manifestation to these steroids. They observed a 20 per cent. incidence of purpuric lesions in a series of 75 patients who received these drugs. Similar lesions were previously observed in patients receiving the original or older steroid preparations (cortisone, hydrocortisone, and corticotropin); however, it has been our experience that this bleeding tendency has appeared with increased frequency since the introduction of the so-called delta-l or meta drugs. The purpose of this report is to call attention to these purpuric lesions and to summarize some studies that have been carried out in an effort to explain the mechanism of their production.