Steroids for Psoriasis: Balancing Benefits and Potential Side Effects

April 14, 2024

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Psoriasis is a common autoimmune disease that causes skin cells to grow too quickly, resulting in itchy, painful plaques on the skin. For many people with psoriasis, flare-ups can have a significant negative impact on their quality of life. When over-the-counter treatments fail to provide relief, prednisone and other steroids may be an option to help manage psoriasis symptoms.

Overview of Psoriasis and Available Treatments

Psoriasis is characterized by areas of thick, red, flaky, itchy skin known as plaques. These psoriasis patches most often occur on the scalp, elbows, knees, trunk, and genitals, but can appear anywhere. While psoriasis itself is not contagious, the plaques can crack and bleed, increasing the risk of infection.

There are various types of psoriasis, including:

  • Plaque psoriasis: Most common variety, characterized by distinct raised plaques
  • Guttate psoriasis: Small, drop-shaped sores
  • Inverse psoriasis: Smooth, red lesions found in skin folds
  • Pustular psoriasis: White pustules surrounded by red skin
  • Erythrodermic psoriasis: Widespread redness and shedding affecting most of the body

While there is no cure, treatments aim to minimize flare-ups and discomfort. Mild cases may respond sufficiently to topical steroid creams or ointments. More severe cases may require systemic therapies like oral steroids, biologics, or phototherapy to reduce inflammation and symptoms.

Prednisone for Treating Psoriasis

Prednisone is a common oral steroid used for suppressing the immune response and reducing inflammation in conditions like psoriasis. As a short-term systemic treatment, prednisone can quickly improve severe skin symptoms while longer-term medications have time to take effect.

Some key points about prednisone treatment for psoriasis:

  • Works rapidly once treatment begins (within a few days)
  • Often prescribed for short-term use only (a few weeks)
  • Requires close medical supervision to minimize risks
  • Can cause unpleasant temporary side effects
  • Does not represent a long-term cure for psoriasis

The most common prednisone dosage for psoriasis patients is between 5-60 mg/day, taken as a single or split dose. Higher prednisone doses may be used initially and then reduced over time. Treatment duration depends on factors like psoriasis severity and patient response.

Benefits and Risks of Using Prednisone for Psoriasis

Prednisone can significantly improve psoriasis symptoms like:

✔️ Skin plaques and inflammation
✔️ Itching, burning and soreness
✔️ Joint pain

It begins working rapidly and results may continue improving over the first couple weeks of treatment. Along with topical steroids and moisturizers, prednisone can effectively bridge the gap until slower medications like biologics reach full effect.

However, prednisone is linked to various side effects when used long-term or at high doses. These may include:

❌ Difficulty sleeping and mood changes
❌ Increased appetite and weight gain
❌ Gastrointestinal issues like nausea, heartburn, or ulcers
❌ High blood pressure and fluid retention
❌ Greater infection risk and delayed wound healing

Doctors generally try to limit prednisone to short courses of a few weeks whenever possible. Psoriasis symptoms often recur after prednisone is stopped. Patients with hypertension, diabetes, or mental health conditions need close monitoring on prednisone due to increased risks.

Still, short-term prednisone administration can provide much-needed relief for those with severe, unstable psoriasis unresponsive to other interventions. Patients and physicians must balance efficacy against safety on an individual basis.

What About Other Steroids for Psoriasis Besides Prednisone?

While oral prednisone is one of the faster-acting systemic treatments for psoriasis flares, other steroid options are sometimes used instead. Reasons may include prednisone not being well tolerated or the presence of complicating health factors.

Some alternatives to oral prednisone steroids include:

  • Topical steroid creams/ointments: Applied directly to skin lesions to reduce inflammation without body-wide effects. However, long-term use can cause skin damage.
  • Steroid injections: Intravenous doses or direct injections into lesions. Fewer systemic effects.
  • Inhaled steroids: Possible benefit for skin symptoms by suppressing immune activity. May also improve psoriasis-related lung inflammation.
  • Non-steroid immunosuppressants: Drugs like methotrexate, cyclosporine or apremilast work by distinct mechanisms to reduce immune overactivity.

Doctors select psoriasis steroid treatments based on factors like disease severity, patient age, medication allergies or intolerance, and existence of other medical conditions. Using multiple therapies concurrently is common.

Conclusion: Weighing Prednisone & Steroids as Part of Psoriasis Care

While not appropriate for everyone, short-term systemic prednisone offers rapid relief from unstable or severe psoriasis flares when safer skin-limited options prove inadequate. Under medical guidance, a brief, high-dose course can bridge the gap until other slower medications reach full effect.

However, prednisone and similar oral steroids are not an effective long-term solution or permanent cure for psoriasis. Lengthy use involves substantial side effect risks without ongoing skin improvements. After discontinuing oral steroids, psoriasis symptoms invariably return over the following weeks.

Working closely with one’s dermatologist allows psoriasis patients to make informed choices about using prednisone and steroids. Correctly balancing effectiveness against safety precautions maximizes the chances for good outcomes. While not ideal, short steroid bursts bring genuine benefits in restoring disease control for some with uncontrolled psoriasis.

FAQs About Steroids for Psoriasis

What is the most common steroid prescribed for psoriasis?

Topical steroid creams and ointments are the most frequently prescribed steroids for managing psoriasis. The highest potency formulations are very effective for reducing skin plaques and inflammation when used cautiously.

How fast does prednisone work for psoriasis?

Most patients notice significant improvements in psoriasis symptoms within 3-5 days after starting oral prednisone treatment. Maximal effect typically occurs around two weeks into therapy. Rapid onset of benefit is a major reason it is utilized for flares.

Can psoriasis return after prednisone?

Yes, psoriasis commonly returns 1-4 weeks after finishing prednisone, often rebounding severely. This medication only suppresses the immune system temporarily. Its effects wear off quickly, allowing inflammation and accelerated skin cell growth to resume.

Is prednisone safe for long-term psoriasis treatment?

No, long-term oral prednisone therapy causes a host of side effects and is not recommended. Safe use is generally limited to a few weeks, with occasional short repeats if needed. Psoriasis always returns after prednisone is stopped.

What reduces the side effects of steroids for psoriasis?

Using the lowest effective steroid dose, avoiding abrupt changes, and limiting length of therapy reduce the likelihood of side effects. Close medical monitoring, preventative care, and prompt attention to emerging problems are also protective steps.

In Summary

  • Psoriasis is an inflammatory autoimmune condition causing skin cell overgrowth
  • Prednisone is a corticosteroid that powerfully suppresses inflammation
  • Oral steroids like prednisone can provide fast, temporary relief of severe psoriasis
  • Treatment duration is typically just a few weeks due to safety concerns
  • All steroids lose effectiveness over time and psoriasis returns once they are stopped
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