Are Systemic or Topical Steroids Best for Psoriasis?
One of the most common treatments for psoriasis is corticosteroids, either taken orally or used as a topical treatment.
Systemic steroids are synthetically made derivatives of the natural steroid, cortisol. They are taken orally or given by injection. The names of these medications include predisone, hydrocortisone, methylprednisone and dexamethasone. According to a study completed in 2013, using systemic steroids as a treatment for psoriasis is not recommended because when the dose is reduced or stopped there is a risk of a flare up or pustular psoriasis. While the use of steroids has been studied for other health conditions, there is not much research into the effectiveness and safety of using these medications for psoriasis.
Despite the fact that this treatment is discouraged, many family physicians and dermatologists prescribe this type of medication for psoriasis. Researchers found that between 1989 and 2010, systemic steroids were prescribed 650,000 times and the large majority of times this was done by a dermatologist. Scott A. Davis, M.S., one of the co-authors of the study is concerned that doctors are prescribing these medications despite the fact that there are newer, effective medications for psoriasis. These medications, he explains, have been researched for their use with psoriasis while the systemic steroids have not.
Topical Steroids for Psoriasis
Topical steroids are the most frequently used treatment for psoriasis according to the National Psoriasis Foundation. They are applied directly to the lesion and help reduce redness and swelling. Topical steroids come in different strengths, ranging from "least potent" to "superpotent." As with systemic steroids, these should be used for only a short period of time and you should not abruptly stop using the steroid as this can cause a flare-up of your psoriasis.
There are concerns about long-term use of steroids, however, most of the side-effects are related to the systemic, rather than the topical steroids. Skin atrophy, or thinning, is the most common side effect of topical steroids. This occurs most often when potent or superpotent steroids are used over a long period of time without a break. Some people can develop stretch marks. When these are noticed early and treatment is discontinued, the stretch marks may disappear. Longer use can cause permanent stretch marks. According to National Eczema Association, "these medications are safest when used intermittently, in an appropriate quantity, and for an appropriate length of time."
In a study completed in 2009, researchers looked at the effectiveness of systemic vs. topical steroids. The scientists found that topical steroids had the potential to reach the same or greater effectiveness than steroids taken orally. The researchers believed that the oral steroids worked more consistently because patients were not consistent in using the topical steroids. The topical steroids, however, are considered to be safer.
If your doctor prescribed steroids, either systemic or topical, it is important to talk about how the medication should be used and the possible side effects. If systemic steroids are prescribed, talk to your doctor about what other treatment options are available and ask why he or she believes this is the best treatment for you.