Steroids are a commonly used treatment of psoriasis and psoriatic arthritis (PsA). Psoriasis is a chronic inflammatory disease that affects the skin. About 1 in 3 people with psoriasis will also develop psoriatic arthritis, a form of the disease that affects the joints.
The steroids used to treat psoriasis and PsA are known as corticosteroids. Corticosteroids are synthetic versions of the natural hormone cortisol, which your body produces in response to stress. They are different from the anabolic steroids some people use to gain muscle mass.
Corticosteroids are used to treat psoriasis because they can suppress the immune system and reduce inflammation. A reduced immune response can help relieve psoriasis symptoms by slowing the growth and buildup of skin cells. Topical treatments can also have vasoconstrictive effects, meaning they can reduce blood flow to the treated area. Reduced blood flow is thought to contribute to reduced inflammation, as well.
Both local and systemic steroids may be used to treat psoriasis. Local steroids include topical creams, ointments, and shampoos applied to the affected skin. For psoriatic arthritis, local steroids may also take the form of injections directly into the joint area. Systemic steroids, which circulate throughout the body, are generally taken by mouth. However, some systemic steroid treatments also include intramuscular (into a muscle) and intravenous (into a vein) injection.
Topical steroids have generally been shown to be highly effective for psoriasis. They may be more effective than treatments such as Psoriasin (coal tar) or retinoids. The use of systemic steroids is also considered effective.
Topical steroids are available in four different potency (strength) levels: mild, moderate, potent, and very potent. For example, hydrocortisone is a mild topical steroid that is available over the counter. Stronger steroids are available by prescription only, such as Elocon (mometasone) Luxiq (betamethasone), and Kenalog (triamcinolone acetonide).
Systemic steroids are generally used in the short term to gain control of severe psoriasis. There has been some controversy over the use of systemic steroids for psoriasis. Some health care practitioners believe that discontinuing systemic steroids may lead to psoriasis flares. However, data from a recent study suggests that the risk for flares following systemic steroids is low.
Corticosteroids can be effective for treating psoriasis, but using them — especially long-term — can result in side effects. Side effects may vary with the dosage and strength of the steroids and are more likely to occur with systemic steroids than topical steroids.
If you use topical steroids, watch for side effects such as:
Watch dermatologist Dr. Raja Sivamani explain some of the side effects of using topical steroids for psoriasis.
The potential side effects of systemic corticosteroids may include:
More serious side effects can include:
If you notice any of the above changes while using steroids to treat your psoriasis, talk to your doctor immediately.
Most steroids are recommended for short-term use, but some people may need to be on them for longer periods of time. When you’re using steroids to treat psoriasis, your doctor should monitor your body weight, blood pressure, blood sugar, vision, and bone density.
If you’re taking systemic steroids, your doctor will likely recommend that you avoid individuals who are sick or have active infections. Systemic steroid use may put you at risk for severe infection from chicken pox, shingles, or the measles if you’re not already immune. You should also consult your doctor before receiving any vaccines while on systemic steroids. Because steroids suppress the immune system, a vaccine may not be as effective. The use of live-virus vaccines is also a concern for people taking steroids.
If you’re stopping long-term use of systemic steroids, work with your doctor to do it gradually over time. A sudden discontinuation of systemic steroids may lead to a serious condition called an adrenal crisis, which occurs because the body can’t make enough cortisol to make up for the sudden withdrawal from the steroid. Side effects of an adrenal crisis include nausea, vomiting, and shock.
Living with psoriasis and identifying effective treatment options for the disease can be challenging. Understanding the benefits and side effects associated with corticosteroid usage can help you make informed decisions about your own treatment. Steroids are just one option for treating psoriasis, and there are many other options to choose from. It’s important to have a conversation with your health care provider to determine what approach is best for managing your psoriasis.
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