Prednisone: The Bait and Switch

The first time I went on Prednisone, I thought I had discovered the answer to all of my psoriasis woes! I was given a large oral dose for a week’s time due to an asthma attack that landed me in the hospital. Having my face balloon up to twice its normal size was worth it as soon as I saw my plaques disappearing before my eyes. But before you run to your healthcare provider and ask them for a script, read on to hear the rest of my experience.

Roid rage

I started noticing the ill effects of this new “miracle drug” after about day four. All of a sudden I started to notice every little smell and noise. If someone or something touched me, it irritated me. I began to yell at my kids for stupid things, like eating too loudly. At first I made excuses such as “I’m still tired from being in the hospital” or “I just need some alone time!” But by the end of day five, it was very obvious that there was something amiss. My wife and kids were avoiding me at all costs and I felt this uncontrollable anger.

The aftermath

I barely finished the course of the medication with my family and marriage still intact. I was remarkably surprised by how quickly the raging feelings went away. Unfortunately, my skin flared almost as quickly as my attitude changed. All of a sudden, I found myself completely inflamed. I swapped angry feelings for angry skin. The flare caused me stress, which caused me to flare more. I went on like this for weeks before it finally started to settle down. I later found out that my body could have reacted worse and developed pustular or erythrodermic psoriasis like other patients I have talked to.

Why it initially worked

Prednisone is an anti-inflammatory steroid that works by targeting the entire body; this is why it is considered a systemic corticosteroid. This is the reason I was prescribed it for my asthma. It helped to reduce the swelling in my lungs and get me back to breathing properly. Since psoriasis is an inflammatory disease, it makes sense that I saw the (albeit temporary) relief of my symptoms.

The controversy

Unfortunately, because of the rebound effect of medications like Prednisone and others like it, it is not recommended for treating psoriasis per US guidelines. Surprisingly, that does not seem to stop providers from giving it out. One study found that in a span of 20 years, an estimated 650,000 of 21 million psoriasis visits ended with a prescription for a systemic corticosteroid.¹ The reason being is that there is not a lot of evidence to back up the theory that these medications cause this worsening of symptoms in psoriasis. There is plenty of anecdotal evidence, as in my experience and others that I have talked to, but that doesn’t seem to be enough discourage the prescribing.

Proceed with caution

Sometimes the need for prednisone is unavoidable. In my case, I was having such a bad asthma attack, that it was critical for me to reduce inflammation quickly. What I have learned is to always talk to my doctor about my reaction. I’ve also found it helpful to let any new providers, such as at an emergency room, know that I have psoriasis and explain my reservations about oral corticosteroids so we can explore other options.