How Safe are Steroids for Psoriasis?

Chances are that steroids for psoriasis have been part of your treatment plan for relieving scaling and inflammation and improving cell turnover, at least at some point in time.

Doctors commonly recommend steroid sprays, lotions, ointments, and creams to help when psoriasis flares.

“Topical steroids remain a mainstay of treatment for inflammatory skin conditions, including psoriasis,” said Christopher G. Nelson Jr., MD, a St. Petersburg, Fla., dermatologist.

However, as effective as they may be for some people, there are risks associated with long-term use, especially if the medications are not used properly.

Corticosteroid Safety: Potential Side Effects

As helpful as they are, corticosteroids for psoriasis do come with a lot of baggage in the form of side effects.

Your health care provider can help you weigh the risks versus benefits for your individual needs.

“Side effects are dependent on the potency of steroid being used — low potency, medium potency, high potency, highest potency — as well as the site of application,” explained Robert J. Michocki, PharmD, a professor in the department of pharmacy practice and science at the University of Maryland.

Possible side effects include:

Resistance to treatment. Steroid treatments that work initially may lose their effectiveness over time as your body develops a resistance to them.

Skin damage. Topical corticosteroids can wreak havoc on your skin. An ultrasonographically detectable decrease in skin thickness can occur after a single application of a very potent topical steroid.

Thinning of skin, loss of elasticity resulting in stretch marks, easy bruising, and dilated surface blood vessels are potential risks associated with steroid use.

These side effects can occur even when low-potency topical steroids are used. Skin changes that are mild typically reverse when you stop using steroids, but more visible changes in skin texture can be permanent.

Systemic side effects. When steroids are absorbed into the skin, you run the risk of them affecting internal organs. This can occur when steroids are applied to large areas of skin, are used for long periods of time, or involve excessive use of occlusion -- covering the affected area with a dressing after applying medication to increase its effectiveness and absorption.

According to Michocki, potential systemic side effects include salt and water retention resulting in increased blood pressure, edema, worsening heart failure, hypokalemia (low potassium in the blood), glucose intolerance with worsening diabetes, osteoporosis, aseptic necrosis (localized death of a portion of bone caused by poor blood supply to the bone), increased risk for infection, and ultimately development of Cushing’s disease from too much cortisol and adrenocorticotropic hormone (ACTH). Cushing’s disease has a long list of complications of its own, such as diabetes; high cholesterol; increased risk for heart attack; osteoporosis; and damage to eyes, kidneys, and nerves from high blood sugar.

Tips for Safely Using Steroids for Psoriasis

“Our goal is to utilize these effective treatments but limit their long-term use to prevent these detrimental side effects,” explained Dr. Nelson. Following these tips will help:

Use the appropriate potency. Limit your chances of developing side effects by using the lowest potency possible. Topical corticosteroids are classified according to strength: very low to very high, with very high-potency compounds being 1,000 times more potent than very low-potency steroids. Corticosteroids for psoriasis are not one-size-fits-all. Different areas of your body require different steroid strengths. “Application to areas such as the groin, underarm, and face usually require a low-potency steroid compared to application to the extremities and trunk, in which a higher-potency steroid can be used,” Michocki said. “I would recommend that you use the least potent steroid that works for the shortest period of time.”

Wear gloves during application. An important tip for safe use is to use gloves for applying the medication, said Matthew Pitlick, PharmD, an assistant professor at St. Louis College of Pharmacy. “If gloves are not used, it is very important to wash your hands with soap and water, extremely well, before and after application. This is especially crucial if applying high-potency corticosteroids,” he cautioned. If topical steroid medication remains on your fingertips, it can be transferred to children, pets, or other parts of your own body.

Rotate steroid use with other treatments. Limit your exposure to steroids by rotating treatment options. “It is often necessary for patients to limit their topical steroid use to only two weeks at a time or to only use them on specific days of the week, such as the weekend,” noted Nelson. “Additionally, many physicians advocate rotating topical steroids with other topical medications, such as topical vitamin D derivatives, topical immunomodulators, or emollients, to decrease the risk of side effects.”

Don’t stop abruptly. When it’s time to stop taking steroids, you may need to taper off use instead of quitting abruptly to avoid triggering a psoriasis flare. Use all steroid medications as directed by your health care provider. In cases of severe side effects, contact your physician to determine the best course of action. However, don’t stop taking any medications without first checking in with your physician.

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