A 55-year-old woman with a history of high blood pressure and chronic obstructive pulmonary disease (COPD) was taking enalapril for blood pressure and using a formoterol inhaler for her lung symptoms. She also had a long-term smoking habit of around 10 cigarettes per day.

When her respiratory symptoms worsened, her pulmonologist switched her inhaler to a combination of indacaterol and glycopyrronium—a long-acting bronchodilator and anticholinergic. However, just two days after starting the new inhaler, she developed painful, red patches on her face and neck, along with a low-grade fever.

She denied using new skin products, eating new foods, or experiencing any recent illnesses. Although she had some sun exposure, she reported using adequate sun protection. The sudden onset and distribution of the rash prompted her care team to refer her urgently to dermatology.

The dermatologist recommended immediately stopping the new inhaler, suspecting a possible drug-induced photosensitivity or allergic skin reaction. A skin biopsy and blood tests were performed to confirm the diagnosis. Meanwhile, she was started on oral corticosteroids to control the inflammation.

Within 24 to 48 hours, she reported significant relief from pain and a reduction in redness, supporting the diagnosis of an acute inflammatory reaction, likely triggered by the new medication.

This case highlights the importance of monitoring for cutaneous adverse reactions when initiating new inhalers, particularly in patients with multiple comorbidities. Early recognition, prompt dermatologic consultation, and appropriate treatment can lead to rapid symptom resolution and prevent complications.