For decades, doctors have been prescribing corticosteroid medications, synthetic versions of hormones made in the body's adrenal glands that suppress inflammation, to treat psoriasis and psoriatic arthritis.
Steroids, which can be applied topically, taken in pill form, or injected, are prescribed to calm flare-ups, but stopping them can also cause flare-ups. Here's what you need to know about using steroids safely.
Most experts think oral corticosteroids should have little, if any, role in the treatment of psoriasis and psoriatic arthritis.
"If patients with psoriasis are prescribed oral steroids, that's a mistake," said Dr. Mark Lebwohl, professor and chair of the Department of Dermatology at the Icahn School of Medicine at Mt. Sinai in New York and chairman emeritus of the NPF Medical Board. "Withdrawal of systemic steroids is the most common precipitating factor in developing pustular or erythrodermic psoriasis, rare life-threatening forms of the disease."
Dr. Ben Ehst, co-director of the Center of Excellence for Psoriasis and Psoriatic Arthritis at Oregon Health & Science University in Portland, agreed, noting, "Oral corticosteroids play a minor part, if any, in treatment. In people with psoriatic arthritis, they may occasionally be used to temporarily relieve pain and inflammation while transitioning to an oral or biologic DMARD (disease-modifying antirheumatic drugs)."
Long-term use can cause osteoporosis, bone fractures, high blood pressure, obesity, diabetes, heart disease, an increased risk of infections, cataracts, poor wound healing, acne and other unwanted side effects, Ehst said.
People with psoriasis who take oral steroids should talk with their doctors about a safe way to transition to other drugs, said Lebwohl.
If you're taking an oral steroid:
Never stop abruptly, as doing so can cause serious disease flares, fatigue and joint pain.
Take it exactly as prescribed by your physician, who will often direct you to take it at the same time each day.
Never double up on pills or take them for longer than prescribed.
Keep in mind that rapid withdrawal of a steroid can leave the body unable to produce enough of its own steroids to support blood pressure and other necessary functions, in rare cases resulting in death.
"If patients with psoriasis are prescribed oral steroids, that's a mistake."
Topical corticosteroids have long been used in the treatment of psoriasis.
"Topical corticosteroids are a mainstay for treating psoriasis, either for patients who have limited skin involvement or, in those with more widespread disease, used in addition to other topical therapies, phototherapy, or systemic therapies," Ehst said.
Although topical steroids rarely cause the serious side effects that oral steroids can, cautions still apply.
Use topicals only on areas for which it was prescribed. Topical steroids vary greatly in strength, from high-potency options used on elbows and legs, to much milder versions for thinner facial, underarm and genital skin and skin folds. Using anything but mild topicals in these sensitive areas can cause permanent thinning, or atrophy, of the skin.
Avoid the eye area, as prolonged use around the eyes can lead to glaucoma and cataracts, said Ehst.
Understand that, when topicals are used long term on large areas of skin, or are particularly potent, they can enter the bloodstream and potentially cause the same side effects as oral steroids. This is particularly true in children, Ehst said.
As with oral steroids, injected steroids for psoriatic disease should be used sparingly, Ehst said.
"Injections can be helpful in treating psoriatic arthritis that is flaring in one or two joints," he said. "This can provide quick relief, but long-term use and repeated injections can actually worsen joint damage and lead to the same complications as oral steroids."
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