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A Guide to Steroid Treatments for Psoriasis

Posted on February 18, 2021

Article written by
Amanda Agazio, Ph.D.

Medically reviewed by
Dr. Ariel Teitel, M.D., M.B.A.

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.

How Are Steroids Used To Treat Psoriasis?

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 (Local) Steroids

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

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.

Side Effects of Corticosteroids

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:

  • Thinning skin
  • Stretch marks
  • Skin-color changes
  • Easier bruising
  • Dilated blood vessels on the surface of the skin

The potential side effects of systemic corticosteroids may include:

  • Muscle weakness
  • Increased appetite
  • Weight gain
  • Mood changes
  • Bruising more easily
  • Swelling in the face
  • Blurred vision
  • Irritation of the stomach
  • Increased body-hair growth
  • Acne
  • Swelling due to water retention
  • Difficulty sleeping

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.

Precautions When Using Steroids

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.

Knowledge Is Power

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.

Talk With Others Who Understand

MyPsoriasisTeam is the social network for people with psoriasis and their loved ones. On MyPsoriasisTeam, more than 88,000 members come together to ask questions, give advice, and share their stories with others who understand life with psoriasis.

How have steroids worked for your psoriasis? Or do you have questions about using a corticosteroid? Share your experience in the comments below, or start a conversation on MyPsoriasisTeam.

References

  1. The Concept of Psoriasis as a Systemic Inflammation: Implications for Disease Management — Journal of the European Academy of Dermatology and Venereology
  2. About Psoriasis — National Psoriasis Foundation
  3. Corticosteroids — Cleveland Clinic
  4. Topical Therapies for the Treatment of Plaque Psoriasis: Systematic Review and Network Meta‐Analyses — British Journal of Dermatology
  5. Psoriasis Treatment — National Health Service
  6. Mechanisms of Action of Topical Corticosteroids in Psoriasis — International Journal of Endocrinology
  7. Systemic Corticosteroid — DermNet NZ
  8. Psoriasis Flares Following Systemic Glucocorticoid Exposure in Patients With a History of Psoriasis — JAMA Dermatology
  9. Steroids — National Psoriasis Foundation
  10. What Is Osteoporosis and What Causes It? — National Osteoporosis Foundation
  11. Steroid Induced Diabetes — Diabetes.co.uk
  12. Cushing’s Syndrome — National Health Service
  13. Steroids and Glaucoma: What's the Connection? — Glaucoma Research Foundation
  14. What Causes Steroid Cataracts? A Review of Steroid‐Induced Posterior Subcapsular Cataracts — Clinical and Experimental Optometry
  15. Prednisone Precautions — Mayo Clinic
  16. Recommendations of the Advisory Committee on Immunization Practices (ACIP): Use of Vaccines and Immune Globulins in Persons With Altered Immunocompetence — Centers for Disease Control and Prevention
  17. Adrenal Crisis — Patient
  18. Psoriasis Pathogenesis and Treatment — International Journal of Molecular Sciences

Amanda completed her Ph.D. in immunology at the University of Colorado Anschutz Medical Campus. Her doctoral studies focused on the antibody response and autoimmunity. Learn more about her here.

Ariel Teitel, M.D., M.B.A. is the clinical associate professor of medicine at the NYU Langone Medical Center in New York. Learn more about him here. Review provided by VeriMed Healthcare Network.

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