Risk and Rewards of Steroids for Psoriasis

Steroids are anti-inflammatory agents which are availa­ble in creams and ointments and come in different strengths. They are normally applied to the skin on a daily basis and are ideal for treating limited areas of psoriasis and sensitive areas like the face, groin and breast.

Aside from being easy to use, topical steroids, which are also called corticoids, cortisone or corticosteroids aren’t messy and can clear up plaques rapidly. Skin treated with steroids can be covered with a plastic wrap or occlusive dressing to intensify their effectiveness.

“The more potent steroids tend to be used on those areas of the body that are more treatment resistant such as the knees and elbows. The lower strength steroids can be used on the more sensitive areas such as the groin, breast and face,” according to the National Psoriasis Foundation (NPF) in Portland, Oregon.

The main problem with steroids is their side effects. Long-term use can cause thinning of the skin, stretch marks, pigment alterations and black-and-blue marks. On the face, topical steroids can cause redness, dilated blood vessels and acne.

With prolonged, uninterrupted use, they begin to lose their effectiveness and can make your condition worse. This is called the “rebound” effect.

“Steroids can stop working after prolonged use. Also, psoriasis can tend to rebound when topical steroids are withdrawn. Often, a physician will gradually taper the patient off a steroid medication to avoid any reaction that might result from sudden discontinuation of the steroid. This ‘rebound’ phenomenon is sometimes seen after using a nylon or plastic occlusion suit following the application of topical steroid medication to large areas of the body,” the NPF said.

Another problem with steroids is that they can be absorbed through the skin and lead to serious ailments like hypertension, diabetes and a puffy or “moon” face. This can occur if topical steroids are used continuously for many years.

No one knows how long these powerful drugs can be safely used before experiencing their side effects. But in general, the patient should see a doctor after more than two months to detect any skin changes. Blood tests can detect how much steroid medication has been absorbed through the skin.

If steroids are prescribed for your particular type of psoriasis, follow your doctor’s instructions carefully and be aware of side effects. Here are some guidelines from the NPF:

One or two daily applications of a steroid medication are generally used. Multiple daily applications do not usually increase effectiveness enough to warrant such frequency.

Overuse of topical steroids can seriously flare an existing case of psoriasis.

Generally, the more potent a steroid medication, the more effective it will be.

If one brand of steroid stops working, switching to another brand of steroid medication may be beneficial. (Next: More tips on steroid use for psoriasis.)

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