If you’ve lived with plaque psoriasis for a while, you may already be a pro at using creams, gels, and ointments to control those itchy red patches. You’ve got many topical treatments to choose from, but one of the most potent is a type of medicine called a topical corticosteroid.
Also known as steroids, corticosteroids bring down swelling and redness, reduce flaky scales, and relieve psoriasis itch.
Corticosteroids are hormones your adrenal glands make to bring down inflammation in your body. In medicine form, steroids quiet your overactive immune system to reduce swelling and redness from psoriasis. These medicines also slow the growth of new skin cells that form scaly patches.
You can get corticosteroids in different types and strengths. Since most topical corticosteroids require a prescription, you’ll work with your doctor to find the one that’s a good fit for your psoriasis.
What Are My Corticosteroid Options?
Topical corticosteroids are divided into groups based on their strength. The corticosteroids in group 1 are the strongest or most potent ones. Those in group 7 are the weakest or least potent.
You can buy these medicines in different forms, including as a:
- Cream
- Lotion
- Ointment
- Gel
- Foam
- Spray
- Shampoo
Some corticosteroids are combined with another medicine to help them work better. Combination products contain a steroid plus a lab-made form of vitamin D or a chemical like salicylic acid.
Which corticosteroid your doctor prescribes depends on the part of your skin psoriasis affects and the severity of your flare. Stronger corticosteroid creams or ointments are better for hard-to-treat psoriasis patches, thick areas of skin like your palms and soles, and places with hair like your scalp.
A mild ointment may be better for plaques on sensitive areas like the face, breasts, groin, and under the arms. Your doctor may also prescribe a shorter course of the medicine for these areas -- 2 weeks instead of the usual 4 weeks.
How Will My Doctor Choose a Corticosteroid for Me?
Your doctor will consider a few things before recommending a corticosteroid for you:
- Whether your psoriasis is mild, moderate, or severe
- Where on your body you have psoriasis patches
- Your age
- What type of topical medicine you’d prefer to use (cream, foam, etc.)
Topical corticosteroids aren’t ideal for large areas of psoriasis. If you have patches on more than 10% of your skin, your doctor might prescribe a pill, shot, or light therapy to treat psoriasis all over your body.
Pros and Cons of Corticosteroids
Corticosteroids work well against psoriasis, which is why they’re the medicine doctors most often prescribe. Many people who use these medicines twice a day will see less redness, swelling, itch, and scale. Some will even get clear skin.
The side effects are the downside. Strong steroids can make your skin thinner if you use them for more than a few weeks or you apply them to areas of skin that aren’t covered in psoriasis. Some people get red streaks called stretch marks or reddened veins called spider veins on their skin. Bruises, acne, and dark or light patches of skin are also possible.
You’re more likely to have these side effects on areas of skin that are already thin, like your face. They might also appear in skin folds like your groin or under your arms. That’s because skin in these places absorbs more of the medicine.
Stronger steroids work better, but they’re also more likely to cause side effects. As long as you follow your doctor’s directions, the chance that you’ll have a problem from your corticosteroid is low.
Your doctor will tell you where on your body corticosteroids are safest to use and how long to use them to avoid side effects. The doctor will also watch for side effects during treatment and help you manage any problems you do have.
How to Use Topical Corticosteroids
Follow your doctor’s directions closely to get clearer skin while avoiding side effects. Use only the amount of medicine your doctor prescribes. Rub the corticosteroid just where you have active psoriasis and not on clear skin. And don’t use this medicine for longer than your doctor prescribes.
Do not use this medication around your eyes unless it’s specifically made for the eye area. Try to avoid getting any of the medicine your eyes. Rarely, topical corticosteroids can raise pressure inside the eye, called glaucoma. Another risk is a clouding of the lens called cataracts.
If you have side effects from this medicine that bother you, check in with your doctor. Don’t just stop using the corticosteroid. Stopping too soon could make your psoriasis flare up.
Ask your doctor how long to use the medication. Usually, you don’t want to use a strong corticosteroid for more than 4 weeks at a time. Your doctor might have you take a break from the medicine for 4 weeks and then go back on it.
Once your skin improves, you may not need to use the steroid as often. You might drop from daily use to just weekends to maintain clear skin.
If your skin doesn’t improve after about 4 to 6 weeks on the medicine, talk to your doctor about other treatment options. You may need to switch to another psoriasis drug or add one to the corticosteroid to get the improvement you want.
Show Sources
Photo Credit: iStock / Getty Images Plus / Getty Images
SOURCES:
American Academy of Dermatology: "Psoriasis Treatment: Corticosteroids You Apply to the Skin.”
BPAC NZ: “Choosing a Topical Treatment for Patients with Chronic Plaque Psoriasis.”
British Association of Dermatologists: “Psoriasis — Topical Treatments.”
InformedHealth.org: “Topical Treatments for Psoriasis.”
Journal of the American Academy of Dermatology: “Joint AAD-NPF Guideline of Care for the Management and Treatment of Psoriasis with Topical Therapy and Alternative Medicine Modalities for Psoriasis Severity Measures.”
Mayo Clinic: “Psoriasis: Diagnosis.”
National Psoriasis Foundation: “Steroids,” “Topicals.”
Psoriasis Association: “Topical Steroids.”
The Psoriasis and Psoriatic Arthritis Alliance: “Steroids.”
UpToDate: “Comparison of Representative Topical Corticosteroid Preparations,” “Treatment of Psoriasis in Adults.”
