Internal use of steroids
At times, a steroid medication is administered internally for the treatment of psoriasis and psoriatic arthritis. There are three methods of doing this: injections directly into the psoriasis lesion (intralesional injections); pills taken by mouth (oral steroids); and injections into the muscle (intramuscular injections).
While oral or injected steroids are generally safe in the short term, there are long-term side effects to consider, including decreased calcium absorption, which can
increase the risk of osteoporosis. Blood sugar levels can also become elevated after using internal steroids, creating an increased risk of diabetes. Discuss the use of internal steroids with your doctor.
Intralesional injections
For one or a few very visible lesions or for lesions that resist clearing with other treatments, your doctor may inject a steroid medication directly into psoriasis lesions, including those on the scalp. Intralesional injections would not be a safe or practical approach for treating numerous lesions on the body or scalp.
Nail psoriasis is sometimes treated by injections of steroid medication into the nail bed or skin folds around the nail. The results vary, and the injections, which can be painful, usually have to be repeated on a regular basis to maintain improvement.
Intralesional injections have few side effects unless they are used too often, for too many lesions or at too high a concentration. If overused, intralesional injections might result in dangerous levels of steroid absorption into the bloodstream. Also, localized thinning of the skin may occur at the site of the injection.
Oral steroids and intramuscular injections
When steroid medications are taken in pill form or injected into the muscle, they are called systemic steroids because they affect the entire body. Administering steroid medications in this manner for the treatment of psoriasis is very controversial, even though it can temporarily clear psoriasis. Most dermatologists, but not all, believe that steroids given in this way have the potential to result in worsening of disease, including flares of pustular psoriasis in people who never had it before. Many doctors believe this can occur even after a single dose of a systemic steroid. People with psoriatic arthritis may require occasional injections into an inflamed joint or have to take low doses of the oral steroids. This type of steroid use has generally not been associated with psoriasis flares.
Updated November 2006
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