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Systemic Corticosteroids

The place of systemic corticosteroid therapy in the management of psoriasis is limited not only by their well known side effect profile, but also by the risk of rebound flaring of psoriasis which may result in life-threatening erythroderma or generalised pustular psoriasis^1,2.

Efficacy

It is therefore generally recommended that systemic corticosteroids should only be used for treating psoriasis in the following circumstances^3,4:

(a) Persistent, otherwise uncontrollable, erythrodermic psoriasis causing metabolic complications.
(b) Generalised pustular psoriasis, if other drugs are contraindicated or ineffective.
(c) Severe psoriatic polyarthritis threatening severe irreversible joint damage.

Safety and side-effects

In a review by Ryan and Baker5 of 104 patients with generalised pustular psoriasis, those in whom systemic corticosteroids were used appeared to have a poorer prognosis and less stable disease. It is difficult to be sure to what extent this resulted from the more severe cases requiring corticosteroid therapy more often, and to what extent the severity of the disease was worsened by the corticosteroid therapy. However, the authors considered that the use of corticosteroids actually worsened the prognosis. Whether or not corticosteroids worsen the long term prognosis, they can be a useful means of controlling this disease in the short term 6.

References

1 Champion RH. Treatment of psoriasis. Br Med J 1966; 2: 993-5.

2 Baker H, Ryan TJ. Generalised pustular psoriasis. Br J Dermatol 1968; 80: 771-93.

3 Camp RDR. In: Textbook of Dermatology. Eds. Rook AJ, Wilkinson DS, Ebling FJG, Champion RH, Burton JL. Fifth Ed 1992; 1391-456.

4 Baker H. Corticosteroids and pustular psoriasis. Br J Dermatol 1976; 94 (Suppl 12): 83-8.

5 Ryan TJ, Baker H. Systemic corticosteroids and folic antagonists in the treatment of generalised pustular psoriasis. Br J Dermatol 1969; 81: 134-45.

6 Lindgren S, Groth O. Generalised pustular psoriasis. A report on thirteen patients. Acta Derm Venereol (Stockh) 1976; 56: 139-47.