Topical Steroids

Topical steroids (corticosteroids or glucocorticoids) are the most commonly prescribed psoriasis medications and they are available as creams, ointments, gels, lotions, oils, solutions, sprays and shampoos. They can be used anywhere on the body and work relatively quickly, often within 1-2 weeks. However, with long-term use, steroids often lose their effectiveness and can cause systemic adverse effects, as well as irreversible skin changes.

Low potency preparations are used for mild cases of psoriasis or on delicate skin areas, such as the groin or face. Medium potency steroids are used when the plaques cover larger areas of skin or if longer treatment duration is needed. High potency preparations are generally used for plaques that are treatment resistant (such as the hands and feet), but their use must be monitored by the prescribing doctor.

How the treatment works

Topical corticosteroids are potent compounds that reduce the body's inflammatory and immune reactions and they are used to treat skin allergies, itching and inflammation.
Corticosteroids prevent the release of substances in the body that cause inflammation.
Low potency preparations are used for mild cases of psoriasis or on delicate skin areas (such as the groin or face).
Medium potency steroids are used when the plaques cover larger areas of skin or if longer treatment duration is needed.
High-potency preparations are generally used for plaques that are treatment resistant (such as the hands and feet), but their use must be monitored by the prescribing doctor.

Advantages/Benefits

Generally, short term courses or intermittent longer term use are not associated with side-effects
They work relatively quickly and are effective at reducing inflammation (redness and swelling) and itching
Efficacy and safety have been confirmed when used in short-term courses and when given intermittently for more lengthy periods
Pulsed betamethasone diproprionate used 3 times, 12 hours apart, has shown to be useful in managing psoriasis. This regimen is suitable for weekend use, while non-steroidal medicines are applied during the weekdays.
Improved efficacy may be achieved when a topical corticosteroid is applied in the late afternoon or evening

Disadvantages/Risks

Even though corticosteroids are applied on the skin, some of the medication is absorbed and enters into the bloodstream.
Long-term or overuse can lead to diminishing efficacy
Other potential side-effects include skin changes (acne, redness, burning, itching and peeling), thinning of the skin, stretch marks (striae), dilated blood vessels, rosacea, perioral dermatitis, bruising, hair growth, weight gain, fatigue, blurred vision, irregular heartbeats, and insomnia.
Side-effects following withdrawal of therapy include progression to a more active form of psoriasis (such as pustular or erythrodermic psoriasis), increased susceptibility to infections, and a flare-ups of psoriasis.
Adverse effects increase when using higher strengths and/or larger areas of the skin are treated
While using this medication, regular laboratory tests may be required to monitor your progress.

Comments & Suggestions

Only use as directed by your doctor. Overuse can increase the frequency and severity of side-effects, and underuse will not produce the intended response from therapy.
Stronger steroids should be reserved for shot-term or intermittent therapy.
Higher-potency steroids should not be used on the face or in skin-fold areas, as these regions are thinner and more prone to developing side-effects from therapy.
Avoid contact with the eyes.