Corticosteroids are chemically synthesized versions of the hormones that our adrenal glands produce. They’re immensely helpful in relieving pain (analgesics) and reducing inflammation (anti-inflammatory). We’ve been using corticosteroids to combat diseases like psoriasis which provoke skin inflammation causing painful and discomforting scaly reddish patches over the skin surface. Steroids are systemic drugs that we consume orally, or via injections and an intravenous drip. Used safely, and under the doctor’s supervision, patients of psoriasis get immense relief from the pain and inflammation.  

How Effective Are Oral Steroids in Helping With Psoriasis?

Experts generally don’t recommend using oral steroids for psoriasis. Make no mistake, doctors are not questioning the efficacy of oral steroids. They are effective in their stated aim of controlling inflammation that is typical of psoriasis. The problems arise when patients discontinue the oral steroids once they notice improvements. Sudden withdrawal of oral steroids increases the chances of developing a very rare and life-threatening disease called pustular or erythrodermic psoriasis. The entire skin surface breaks out in reddish rashes; the discomfort is severe and so is the pain.

The general consensus is that oral steroids are safe to use in a limited way. For example, there’s a patient suffering from severe psoriatic arthritis who needs to switch from corticosteroids to Disease-modifying antirheumatic drugs (DMARDs). An oral steroid can control inflammation during the period when the body switches to the new drug.

Using oral steroids over a longer term can trigger many serious ailments like the weakening of the bones leading to fractures. There’s a higher risk of acquiring lifestyle diseases such as high blood pressure, obesity, diabetes, and heart disease. Eye problems like cataract and slower wound healing are other potential side effects of prolonged oral steroid treatment.  

If You Wish to Stay on the Safer Side of Oral Steroids, Avoid Certain Situations

  • Sudden withdrawal of steroids can cause psoriasis and arthritis to flare uncontrollably. In some instances, patients died because the body could not replace the withdrawn dosage of oral steroids and the body had no means to control the rapid flare-up of inflammation.  
  • Even if the pain and discomfort of psoriasis increases, never succumb to the temptation of taking an extra pill. Self-medication and overdosing are dangerous.
  • Oral steroids are given for a specific period. Never extend the duration without first getting your condition reviewed by the doctor.  

How Safe Are Topical Steroids in Treating Psoriasis?

From mild to moderate and extreme cases of skin inflammation, topical steroids have found extensive use in treating psoriasis. Topical steroids work well with other treatment options such as systemic medication and Photochemotherapy. But are topical steroids safe? Topical steroids have wider acceptance among medical experts precisely because they don’t carry the risks posed by oral steroids. The use of topical steroids should be strictly confined to the parameters framed by medical experts:

  • Apply topical steroids in small quantities only over the areas that are affected. Topical steroids come in varying potency – from mild to medium and high-potency. How you use them and where you apply them depends on the area that is affected. The area surrounding the eyes, the face, the armpits, the genital areas, and crevices where the skin folds over itself demand the mildest steroids.

 

  • Applying stronger potency steroids over sensitive skin may cause the skin to thin out. This seriously affects the elasticity and flexibility of the skin, besides damaging the skin’s blood vessels, sweat glands, and hair follicles. Arms, legs, and elbows can tolerate high-potency steroids because the skin is rougher and more capable of withstanding the side effects of steroidal use.
  • A topical steroid (of whatever potency) applied over a larger skin surface for a prolonged period can be extremely damaging. Steroids are directly absorbed through the skin into the network of blood vessels just below the surface. Through extensive usage, steroids spread to all parts of the body. If topical steroid levels build up inside the body, they have the potential to create the same havoc as oral steroids. This can happen when you apply excessive topical creams in treating children suffering from psoriasis.

Used safely, topical steroids offer you a better option to treat psoriasis without risking the side effects peculiar to oral steroids.

Does Injecting Corticoids Make a Difference to Psoriasis?

We’ve come to a very popular treatment option for psoriasis – the corticosteroid injection. Most patients, especially those with severe psoriasis symptoms, opt for the cortisone shot because it is fast-acting, the effect is targeted and comprehensive, and the relief lasts longer.

The injection presents a flexible way of reaching the affected area. One method is to needle a prominent vein or a muscle. If you’re dealing with a painful joint, the needle goes into the fluid-filled sac (bursa) that lubricates movement or into the softer tissue around the tendons. This method is widely used in treating inflamed joints in psoriatic arthritis.

The advantage of an injection is that a high-potency steroid goes directly into the affected area and doesn’t spread all over the body as in the case of oral steroids. So you get leeway in suppressing side effects. You also get the opportunity to avoid potentially dangerous oral steroids.  

The effectiveness of the injection is such that you can combine steroids with pain relievers and any other medication that will calm the inflammation and relieve pain faster. The injection can be administered just before a physiotherapy session. Such combination treatments are very effective in tackling psoriasis.

Specific Situations Where Steroid Injections Are Not Beneficial

If the skin inflamed by psoriasis happens to be infected or if there’s an existing infection say in the lungs or some other area, doctors avoid injections. This is because steroids may interfere with other medications used to combat infection. The same holds true if a joint is too damaged to be repaired. In such cases, an artificial prosthetic replacement for the joint would be a better remedy.

Injections are avoided if there is bleeding or in a situation where the patient is being treated with blood thinners (anticoagulants). In such cases, steroids may complicate the situation at the psoriasis site.

Too many injections taken too frequently can weaken the immune system to the point that tissues collapse in psoriasis affected areas.

The major issue with steroid injections is that the steroids remove pain and bring down inflammation without curing the underlying problem. Through frequent use, you aggravate many side effects, some of them being long-term. So we need to exercise a great deal of caution in handling such medical tools.

How You Combat the Risk of Corticosteroid Side Effects

As we discussed, corticosteroids come in different degrees of potency, and the severity of psoriasis decides how much potency is required. As a rule, children are given the mildest doses. Adults may need high-potency steroids given under personalized care and medical supervision.

The facial area, genital system, and areas with skin folds are not the best sites for high-potency treatments. Sessions should not be extended beyond four weeks. Even in such cases, you need to give a holiday of up to four weeks to prevent side effects from entering the picture. Vitamin D infusions and other non-steroidal therapy can be considered during the break.    

The Medical Review Is an Essential Part of Corticosteroid Treatment

An adult needs to be reviewed after four weeks of steroid treatment. For children, it is for two weeks. If steroid treatment fails to yield results, other options need to be explored. If progress is visible, the doctor assesses the need for continuing treatment, and how long the treatment should go on.

We may face the scenario where a patient abruptly stops steroid treatment and is facing a renewed flare-up more virulent than the previous instance. This is a dangerous moment fraught with complications where a medical review is a must to chalk out a fresh treatment strategy.

The consulting physician will be in a better position to explain to patients that after the initial exertion of intense steroid treatment, subsequent sessions can be spaced out as and when psoriasis creates discomfort.

Conclusion

Do steroids help with psoriasis? They definitely do, and you’ll be pleased with the results when the inflammation subsides, and pain relief follows quickly. Although steroids are very effective in the treatment of psoriasis, doctors say they face a high incidence of customers abandoning treatment midway thinking that they can pull on without steroidal intervention. For a favorable outcome, follow the good doctor’s advice, weigh all options and go through the sessions no matter how tiresome they seem. Remember that you’re handling a chronic disease with no cure in sight, so use the steroidal tools with care to maximize your post-therapy recovery.