| Psoriasis
Treatment (Part 3) Treatment of Psoriasis
Topical
Steroids
Topical steroids are anti-inflammatory
medications that reduce skin inflammation present in
psoriasis. Topical steroid creams can help bring the
itch of psoriasis under control and decrease the thickness
of the outer layer of the skin. Corticosteroids are
the most commonly prescribed topical therapy for the
management of psoriasis and are available in several
forms, including ointments, creams, lotions, aerosols
or tapes (in the United States). An advantage of topical
steroids is that they work relatively quickly and the
cost is quite reasonable. |
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Steroid
Potencies
Topical steroids range from low
to high or ultra-high potency. Ointments are usually
more potent than creams that contain the same concentration
and type of steroid.
In general, doctors may start
psoriasis patients using low to mid-potency steroids.
The strength and base (i.e., ointment or cream) of the
steroid used may be varied according to the site and
the type of psoriasis lesions. For example, thick plaques
of psoriasis on the elbows and knees may require higher
potencies in an ointment form in order to obtain penetration
through the thick skin in these locations.
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Salicylic acid may be combined with the topical steroid
as it reduces the scaling and can help increase steroid
penetration. On the other hand, doctors generally like
to use low potency steroids in very sensitive areas where
the skin is thin, such as in the genital region, the face
(e.g., eyelids), and folds (crease between the buttocks,
under the arms and breasts). Treatm
Most topical steroids are available
by prescription only. Only milder topical steroids (e.g.,
hydrocortisone 0.5%) are available from the pharmacist
without a prescription. Examples of some of the different
types of corticosteroids that are available as creams,
ointments, gel, foams, lotion and solutions are listed
below according to their potencies.
What Are the Possible Complications
of Topical Steroids?
Steroids have been used extensively
for long periods and are very safe when used appropriately.
However, topical steroids can have certain side effects
when they are either highly potent or used over long
periods, and when used in more sensitive areas where
the skin is thin.
Tips
for Topical Steroid Therapy
If you have very thick, scaly
lesions it might be necessary to apply salicylic acid
(either in combination
with a topical steroid, or in a topical
cream or ointment, as prescribed by your doctor) to
reduce the
scales and enable the active medication
to penetrate the skin better.
If you are applying to very thin
skin (such as the genitals or face), check with a doctor
or pharmacist
that the potency of the steroid you
are using is right for you.
Avoid applying stronger steroids
to the face or skin folds unless instructed by a doctor.
Also, make
sure you know how long your doctor
wants you to use them (usually only a few weeks), especially
when applied to these sensitive areas.
The most common side effects reported
with prolonged use of potent corticosteroids are stretch
marks (striae) and thinning of the skin (atrophy). Both
of these side effects occur with prolonged use of treatment
(after at least one month of continual use), and tend
to occur in areas where the skin is more sensitive or
thin, especially the armpits and groin. Thinning of
the skin is usually reversible if caught early and treatment
is stopped. Stretch marks can also occur and are usually
irreversible. Other side effects include:
increased darkening of the skin
(hyperpigmentation)
increased lightening of the skin
(hypopigmentation)
acne (perioral acne)
acne-like eruptions (rosacea)
contact or irritant dermatitis
easy bruising (purpura)
inflammation of the hair follicle
(folliculitis)
increased blood vessel formation
infection
rebound of psoriasis (on stopping
the treatment, usually abruptly)
loss of response (tachyphylaxis)
Possible
but rare side effects include:
glaucoma (increased pressure
in the eye)
Cushing's Syndrome (a hormonal
disorder caused by prolonged exposure of the body's
tissues to
high levels of the hormone Cortisol)
decreased growth in children
(very rare)
Never abruptly discontinue the
use of potent topical steroids, unless advised by your
doctor or if you are having a reaction to the medication,
or you might experience a rebound or flare of psoriasis
or a temporary worsening of the lesions.
Some people might be unable to
use topical steroids, particularly if they have any
known allergy to corticosteroids or any component in
it, and/or any bacterial, fungal or viral infections
at the site of application.
In addition, topical steroids
can lose their effect over time. This is termed "tachyphylaxis,"
meaning the body has developed a tolerance to the beneficial
effects of the medication.
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