Topical steroids were the first and longest treatment I have used for my psoriasis. When first prescribing them, my dermatologist said very little about their associated risks and only cautioned me to take days off every so often to prevent thinning skin.
I’ve tried topical steroids in many forms and, to be fair, they have worked for me to eliminate scaling and to flatten psoriasis patches to the point where they are faintly pink. However, in my experience, as soon as I stop using steroids, the psoriasis returns. In this way, it feels more like a Band-Aid solution. Frankly, most psoriasis treatments feel this way! I know they are merely suppressing the symptoms rather than actually healing me from the disease. Still, I use them to stay comfortable.
For about a year, I was using topical steroids on my entire body. I used a lower-strength steroid cream for my face and genitals. On my body, I cycled through a few forms before finding the best one for me. I started with a lower-strength ointment, which was manageable when my coverage was mild. However, applying it required painstaking attention when I was more covered. Eventually, I switched to a stronger steroid solution in spray form, which was much easier to apply all over my body.
I’ve also tried moderate-strength steroids in oil form, which were again easier to slather on but not strong enough to make any noticeable changes in my skin. With the spray and the oil, I was pleased to be able to easily cover a lot of skin. However, I knew I was increasing my steroid exposure by not bothering to avoid my few patches of healthy skin amongst the psoriasis lesions. When I spent 45 minutes applying the ointment dot by dot, I was able to avoid these healthy areas and thereby limit my steroid exposure.
I still use a topical solution and an oil on my scalp, which effectively address the scaling and itch but make my hair completely unpresentable. The topical solution, which I apply in streaks on my scalp and then rub in to spread, gives me a greasy look that resigns me to a messy bun — my only hairstyle since psoriasis. I apply the oil a couple times a week and then sleep with a shower cap on, but this only works if I plan to wash my hair the next morning. Washing my scalp irritates my scalp psoriasis: The itch is always the worst after a shower, so I always struggle to decide whether oiling is worth it. I am also still using a liquid steroid in the form of eardrops to address the psoriasis in my ears — another one of my itchier spots.
Although topical steroids have helped my scalp and body, they have wreaked havoc on my face. After I’d spent several months using a low-strength steroid on my facial psoriasis patches, my skin erupted in a bout of perioral dermatitis. My dermatologist said this was a potential side effect of topical steroid usage on the face. Why hadn’t he mentioned this earlier?!
I’ve had to stop using steroids on my face and have since been on a cycle of oral and topical antibiotics to manage the perioral dermatitis flare-ups. Because of this, I would seriously caution anyone against using steroids on their face. It’s been a nightmare.
As I am now on biological treatment, I thankfully need to make use of steroids less and less. They still have their place in my psoriasis management routine, but I now recognize that they are not without risk.
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