Corticosteroids for psoriasis
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Corticosteroid creams or ointments of various strengths may be used to treat psoriasis. If a milder form doesn't work, a more potent (stronger) cream will be prescribed.
Corticosteroid creams, lotions, ointments, and solutions are classified in order of potency: class I (the most potent) to class VIII (the least potent).
To treat psoriasis, creams are applied once or twice a day.
As symptoms improve, the doctor may recommend a milder cream or may recommend that you apply it less often (for example, weekend use only).
The dosage is sometimes decreased to prevent developing drug tolerance. Or the doctor may rotate a corticosteroid with other medicines. For example, you may use a corticosteroid on the weekend but another topical (applied to the skin) medicine during the week.
How It Works
Corticosteroids applied to the skin (topical) reduce inflammation, itching, and the growth of skin cells.
Why It Is Used
Corticosteroids applied to the skin are the most commonly used medicines to treat psoriasis.
Topical corticosteroid medicines are used for:
- Mild to moderate psoriasis (patches cover less than 10% of the skin surface, or less than the skin area on one arm and hand).
- Patches that are resistant to treatment, especially on the hands and feet.
- Erupting guttate psoriasis (a type with many small patches).
Milder corticosteroid creams may be used on the face, groin, and armpits and on guttate patches. Stronger creams may be used on chronic plaque-type psoriasis.
Corticosteroid pills are rarely used because of potential serious side effects with long-term use. Corticosteroid injections are often not practical if a large area of skin is affected.
How Well It Works
How well the product works depends on how strong it is, what kind of cream or ointment is used, where it is applied, and how much of it is absorbed into the skin. Medium-strength and high-strength corticosteroids are not used where the skin is thin, such as on the face or the genitals. The use of corticosteroids is limited by their side effects and short-term effectiveness.
High-strength products are effective on areas of thick skin, such as knees and elbows.
Side effects of corticosteroid creams include:
- Thinning of the skin, stretch marks, skin color (pigmentation) changes, or easy bruising with higher strength corticosteroids.
- Symptoms of psoriasis that return quickly when the medicine is stopped.
- Local burning, itching, irritation, dryness, or redness of the skin after the creams are used.
To limit serious side effects, your doctor may recommend that you:
- Have regular follow-up visits with a doctor, nurse practitioner, or physician assistant to make sure you are using the medicine properly.
- Do not apply more than 100 g (4 oz) of a class III or lower (more potent) corticosteroid in a month.
- Spend a period of time each year using another treatment, such as tar products or ultraviolet (UV) light exposure.
See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)
What To Think About
As symptoms improve, your doctor may recommend a milder cream or may recommend that you apply it less often (such as weekend use only).
High-strength corticosteroids are used for short lengths of time to reduce the risk of side effects.
Corticosteroids taken by mouth (oral) often lead to severe rebound psoriasis (psoriasis that returns and is worse than before treatment) when you suddenly stop taking the drug. Oral corticosteroids are rarely used to treat psoriasis.
Occlusive dressings (such as DuoDerm) moisturize the skin and reduce the redness, thickness, and amount of scaling of the skin. They help remove scale and increase the effectiveness of corticosteroid creams. But occlusive dressings also increase the risk that the drug will be absorbed into the body and disrupt the body's hormonal system. Regular follow-up with a doctor is needed whenever these products are used with corticosteroid creams.
Exfoliative psoriasis, in which the rash covers the entire body, may occur after long-term use of high-dose corticosteroid creams or pills.
- Naldi L, Rzany B (2009). Psoriasis (chronic plaque), search date August 2007. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
- Habif TP, et al. (2005). Psoriasis and other papulosquamous diseases. In Skin Disease: Diagnosis and Treatment, pp. 106–115. Philadelphia: Elsevier Mosby.
Last Revised: January 6, 2010
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