Important Facts About Corticosteroids for Psoriasis
If you’re dealing with itchy, scaly psoriasis plaques, your dermatologist might prescribe a topical treatment—that’s anything that’s applied on the skin, like an ointment, cream, or foam. There are several different types of topicals available, and corticosteroids are one of the more commonly prescribed. If you’re using—or are considering using—corticosteroids, you’re likely wondering how they work, how to avoid side effects, and what results to expect. Here, experts explain all that and more.
What Are Corticosteroids?
Corticosteroids were developed based on the natural corticosteroid hormones produced by the body’s adrenal glands. “They are very potent anti-inflammatory molecules that are used to treat a very wide range of chronic inflammatory and autoimmune diseases,” explains Anthony Fernandez, M.D., Ph.D., a dermatologist at the Cleveland Clinic in Ohio.
For people with psoriasis, corticosteroids are applied directly to affected skin to slow excess skin growth and reduce plaques, redness, and swelling.
“They are the mainstay of topical psoriasis treatment,” says Saakshi Khattri, M.D., an assistant professor of dermatology at the Icahn School of Medicine at Mount Sinai Hospital in New York City.
How Do Corticosteroids Work for Psoriasis?
While we don’t know exactly what causes psoriasis, it’s thought that overactive immune-system activity speeds up skin-cell growth, causing inflammation and excess skin cells to pile up on the surface of the skin, leading to psoriasis symptoms.
Topical corticosteroids help control the underlying inflammatory response in the body, and, in turn, relieve psoriasis symptoms.
What Formulas Do They Come In?
The topical corticosteroids used for psoriasis treatment typically come in a tube or jar, and are available in a variety of different formulations, such as:
They also come in various strengths. Where more mild topical corticosteroids may be available over-the-counter (i.e., hydrocortisone 1%), stronger potencies are available via prescription only, and your doctor will help you find the right one for your psoriasis. A few examples are betamethasone, desonide, and triamcinolone.
Finding out which topical corticosteroid (or treatment combination) works best to help alleviate your psoriasis symptoms may take some trial and error. “There’s no singular one that’s most common,” explains Khattri. “All topical steroids can be used for psoriasis treatment, depending on the location of the lesions and the patients’ ease of use.”
Generally, high-strength topical steroids are used for areas of thicker skin like elbows or knees; medium-strength topical steroids are used for the body; and, low-strength topical steroids are used for the face, genitals, and armpits.
What Are the Potential Side Effects of Topical Steroids?
The most common side effects from these topical steroids are those that affect the skin, such as:
- Skin atrophy, or thinning of the skin
- Changes in skin pigmentation (lightening or darkening)
- Telangiectasias (development of blood vessels)
In some cases, especially with more potent formulations, the steroids can be absorbed through the skin and affect internal organs.
“The different potencies or strengths, as well as the different anatomical locations affected, are important when thinking about the potential side effects of these medicines,” explains Fernandez. “For example, more potent corticosteroids are used when psoriasis affects the palms of your hands or soles of your feet, where your skin is very thick. But we try to avoid potent steroids on areas like the face, under the arms, on the breasts or genital areas where the skin is more prone to atrophy and doesn’t always go back to a normal thickness easily once you have that change.”
The risk of potential side effects can also determine how long you’re instructed to use it for—usually around three weeks or less. “Skin atrophy from chronic use is a concern, so patients are always counseled to not use it beyond specified periods of time,” says Khattri.
Ultimately, it’s a balancing act. “We always make sure the patient has more benefits than adverse effects,” says Fernandez.
Who Can Use Corticosteroids?
“We prescribe topical steroids to the full spectrum of psoriasis patients,” says Fernandez. “We prescribe them to patients of all ages, who have all different severities of psoriasis, who have all different subtypes of psoriasis, and really any location of psoriasis.”
Topical corticosteroids are the first-line treatment for people with mild psoriasis. They’re commonly covered by most insurance companies, and they’re very affordable even without insurance, since costs range from $5 to $50. For more severe psoriasis, a systemic treatment, such as an oral or injectable biologic medication, may be needed, but a topical can also be used in combination with those, says Fernandez. Sometimes, even people on systemic medications may have a stubborn plaque that will not go away, or a flare. In these situations, topical steroids may be needed to clear the plaques.
“Anyone can use corticosteroids,” adds Khattri, “though, for children, generally a lower potency for shorter periods of time is preferrable. Data on the safety of topical corticosteroids in pregnancy is limited, but based on available evidence, the use of low- to mid-potency topical corticosteroids does not seem to increase the risk of adverse outcomes for the mother or the fetus.”
What Types of Results Can I Expect?
“If you’re using them correctly, you should notice that there’s a significant thinning of psoriatic plaques, less scaling, and a decrease in associated symptoms like pain or itching,” says Fernandez. “In some areas, you should be able to see complete resolution of psoriatic plaques, but compared to systemic medications, there’s less chance the plaques are going to completely resolve.”
If you experience new or worsening symptoms, it’s important to see your dermatologist. “Topical steroids treat existing lesions, but they do not prevent new ones from developing,” adds Khattri.
It’s important to know that stopping topical steroid therapies can sometimes result in a rebound phenomenon—meaning the psoriasis comes right back. So, working with your dermatologist to find the right combination of topical steroids and nontopical steroids (such as calcipotriene, pimecrolimus, and tacrolimus) is crucial for keeping your psoriasis away.
How Can I Ensure I’m Using My Topical Corticosteroids Safely?
“The really important thing is to use them correctly,” says Fernandez. Keep these tips in mind when you’re prescribed a topical corticosteroid:
- Apply it in small amounts to affected area only, avoiding the eyes.
- Do not apply it any more frequently than directed by your doctor.
- Don’t cover the area with a bandage, unless your doctor directs you to.
- Apply it during a time when the product can absorb into your skin without rubbing off onto clothing or bedding.
- Don’t stop taking it abruptly without approval from your dermatologist.
- Don’t use it for more than three weeks without approval from your dermatologist.
When you don’t apply the medication exactly as directed, there’s an increased chance of side effects. “We have to make sure the patient is getting more benefit than harm from the medicine,” says Fernandez.
If you have additional questions about your topical corticosteroid treatment regimen, be sure to ask your dermatologist.
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