I need to speak about this journey. I have lost years of quality singing, not knowing what was wrong. My singing voice has been my travel companion throughout my life – it is not merely my profession. The gradual weakening of my singing voice affected my mental, emotional, and psychological health. Losing one’s voice is a grave loss—there are no words to describe the grief it brings. Perhaps if the medical professionals who treated me had known about these adverse effects they would have sought alternative therapies for me, or at the very least, lowered my dosage of ICS. I believe the discontinuation of non-steroid treatment for asthma in the . should be reconsidered. As it now stands, I am on maintenance level allergy injections monthly, one dose of Singulair (Montelukast) nightly, and only occasionally do I use my emergency inhaler. This treatment is working well. I write to warn singers of all varieties, professional and non-professional, and others whose livelihoods depend upon their voices, of the negative effects of inhaled corticosteroid treatment on the voice. I also write to draw the attention of physicians who prescribe these medications, as well as the pharmaceutical companies and retailers who produce and profit from them, to the well-documented adverse side effects of long term, sustained usage to the human voice.
There is some evidence that sun exposure can accelerate steroid-induced skin atrophy, the development of which can be limited by protecting the skin, particularly the face and arms, from the sun. Daily use of a broad-spectrum sunscreen (UVB and UVA block) and appropriate protective clothing is recommended. 10 , 12 - 14 Patients on corticosteroids should also be encouraged to regularly use moisturisers on their arms and legs, as these may reduce bruising and tearing of the skin from minor trauma. 11 Evidence suggests that topical tretinoin can increase the epidermal thickness of sun-damaged atrophic skin, but long-term use may be necessary. 14 In dermatological practice, topical retinoids are used to help reverse skin atrophy caused by sun exposure or corticosteroid use.
In an embryofetal development study in pregnant rabbits, beclomethasone dipropionate administration during organogenesis from gestation days 7 to 16 at subcutaneous doses equal to and greater than times the MRHDID in adults (on a mg/m 2 basis at maternal doses of mg/kg/day and higher) produced external and skeletal malformations and embryolethal effects (increased fetal resorptions). There were no effects in fetuses of pregnant rabbits administered a subcutaneous dose times the MRHDID in adults (on a mg/m 2 basis at a maternal dose of mg/kg/day).