Methods of using topical steroids
Applying steroids to lesions
Apply the steroid medication directly to the psoriasis lesion for which it was prescribed, and as often as prescribed (usually once or twice per day). Do not apply the medication to uninvolved skin. Using the steroid more than prescribed is not helpful and can actually damage the skin.
Occlusion
Some people apply steroid medications to psoriasis lesions and cover the area with an airtight plastic wrap, cellophane dressing, waterproof dressing or a nylon suit. This is called occlusion. Occlusion can increase the effect of the steroid and the amount of medication absorbed into the skin.
Always check with your doctor before occluding a steroid medication. Although occlusion is an often reliable treatment option, many steroids are too strong to cover. Occlusion can increase the effectiveness of a steroid medication, but it can also intensify the side effects such as skin atrophy (thinning of the skin), skin sensitivity and systemic absorption (see side effects). Your doctor can decide if occlusion is appropriate for you.
Pulse-dosing
Pulse-dosing refers to a steroid application schedule that can minimize the risk of side effects. In a typical schedule a patient might clear lesions with daily applications of a potent steroid. Once the psoriasis lesions clear, the steroid application is reduced to a few times per week.
Using topical steroids to treat scalp psoriasis
Topical steroid medications are frequently used to treat the scalp. Normally, potent steroids can be used safely to treat scalp psoriasis, though generally they should not be used for long periods of time unless absolutely necessary. Several topical steroid medications are designed specifically for use on the scalp. You may want to use a shower cap when sleeping, or change your pillow cover regularly to avoid transferring the medication to unaffected parts of the body.
Children and topical steroids
In most cases, experts feel that mild- to mid-strength topical steroids are safe for children if used on small areas of the body. Potent steroids can be used sparingly with careful monitoring, usually for very brief periods of time. Steroids used over the whole body or in potent strengths can affect a child's growth and cause side effects if overused, so the guidance of a doctor is important.
Topical steroids, pregnancy and nursing
Women are often advised to stop some psoriasis treatments before conceiving and during pregnancy. Your doctor can provide direction about the localized use of steroids during pregnancy.
If you are nursing, you should also discuss the use of topical steroids with your doctor. Topical steroids can be absorbed through the skin and get into the breast milk. Work closely with your doctor to determine what is an acceptable treatment regimen when nursing.
For more information about psoriasis and conception or pregnancy, see conception, pregnancy and psoriasis.
Updated November 2006
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