Discusses topical corticosteroids (creams, lotions, and ointments) used to treat psoriasis. Covers how they work and where they may be used. Also discusses how well they work and side effects. Offers tips on how to limit side effects.
Corticosteroids for Psoriasis
Corticosteroid creams or ointments of various
strengths may be used to treat
psoriasis. If a milder form doesn't work, a more
potent (stronger) cream will be prescribed.
Corticosteroid creams, lotions, ointments,
and solutions are classified in order of potency: class I (the most potent) to
class VIII (the least potent).
To treat psoriasis, creams are
applied once or twice a day.
As symptoms improve, the doctor may
recommend a milder cream or may recommend that you apply it less often (for
example, weekend use only).
The dosage is sometimes decreased to
prevent developing drug tolerance. Or the doctor may rotate a corticosteroid
with other medicines. For example, you may use a corticosteroid on the weekend
but another topical (applied to the skin) medicine during the week.
How It Works
Corticosteroids applied to the skin
(topical) reduce inflammation, itching, and the growth of skin cells.
Why It Is Used
Corticosteroids applied to the skin
are the most commonly used medicines to treat psoriasis.
corticosteroid medicines are used for:
Mild to moderate psoriasis (patches cover less
than 10% of the skin surface, or less than the skin area on one arm and
Patches that are resistant to treatment, especially on the
hands and feet.
Erupting guttate psoriasis (a type with many small
Milder corticosteroid creams may be used on the face,
groin, and armpits and on guttate patches. Stronger creams may be used on
chronic plaque-type psoriasis.
Corticosteroid pills are rarely
used because of potential serious side effects with long-term use.
Corticosteroid injections are often not practical if a large area of skin is
How Well It Works
How well the product works depends
on how strong it is, what kind of cream or ointment is used, where it is
applied, and how much of it is absorbed into the skin. Medium-strength and
high-strength corticosteroids are not used where the skin is thin, such as on
the face or the genitals. The use of corticosteroids is limited by their side
effects and short-term effectiveness.
Corticosteroid creams are
effective for short-term relief of psoriasis.1 Use of corticosteroid creams turns thick, red skin plaque
into thin, flat areas that are more comfortable and less visible.
High-strength products are effective on areas of thick skin, such as
knees and elbows.
Side effects of corticosteroid creams
Thinning of the skin, stretch marks, skin color
(pigmentation) changes, or easy bruising with higher strength
Symptoms of psoriasis that return quickly when the
medicine is stopped.
Local burning, itching, irritation, dryness,
or redness of the skin after the creams are used.
To limit serious side effects, your doctor may recommend
Have regular follow-up visits with a doctor,
nurse practitioner, or physician assistant to make sure you are using the
Do not apply more than
100 g (4 oz) of a class III or
lower (more potent) corticosteroid in a month.
Spend a period of
time each year using another treatment, such as tar products or ultraviolet
(UV) light exposure.
See Drug Reference for a full list of side effects. (Drug
Reference is not available in all systems.)
What To Think About
As symptoms improve, your doctor
may recommend a milder cream or may recommend that you apply it less often
(such as weekend use only).
High-strength corticosteroids are used
for short lengths of time to reduce the risk of side effects.
Corticosteroids taken by mouth (oral) often lead to severe rebound
psoriasis (psoriasis that returns and is worse than before treatment) when you
suddenly stop taking the drug. Oral corticosteroids are rarely used to treat
(such as DuoDerm) moisturize the skin and reduce the
redness, thickness, and amount of scaling of the skin. They help remove scale
and increase the effectiveness of corticosteroid creams. But occlusive
dressings also increase the risk that the drug will be absorbed into the body
and disrupt the body's hormonal system. Regular follow-up with a doctor is
needed whenever these products are used with corticosteroid creams.
Exfoliative psoriasis, in which the rash covers the entire body, may
occur after long-term use of high-dose corticosteroid creams or pills.
Naldi L, Rzany B (2009). Psoriasis (chronic plaque),
search date August 2007. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
How this information was developed to help you make better health decisions.