What Are Topical Corticosteroids?
Topical corticosteroid medicines, also called steroids, are applied directly to the skin to treat the symptoms of psoriasis. They are a very frequently used treatment and are usually the first type of treatment that people with mild psoriasis will be advised to try1. People with moderate to severe psoriasis will often use topical corticosteroids in combination with more powerful systemic medicines that affect the way the immune system functions2.
How do topical corticosteroids work?
Psoriasis is a chronic autoimmune condition that causes inflammation in the body. This inflammation triggers the production of an excessive amount of new skin cells that are produced more quickly than the body can shed older skin cells naturally1. Plaques are patches of thickened, red, and scaly skin that develop due to a buildup of skin cells on the surface of the skin.
Topical corticosteroids are types of anti-inflammatory medicines. They are effective because they work in several different ways to relieve the symptoms of psoriasis, although precisely how they work is not yet understood. Corticosteroid treatments are made to act like natural substances in the body called corticosteroid hormones, which are involved in many different functions of the body, including the process of inflammation2.
For many people with psoriasis, treatment with topical corticosteroids can:
- reduce the production of new skin cells
- decrease inflammation and reduce swelling
- decrease redness
- relieve itchiness
How are topical corticosteroids applied?
Topical corticosteroids are available in many different forms (also called bases) to deliver medicine into the skin in various ways. These include:
How often the corticosteroid is applied will depend on the type of base, where the symptoms are located, and how severe the symptoms are. Your healthcare provider will advise you about how often to apply the medicine safely.
Topical corticosteroids are available in a wide range of different strengths, from Class 1 (very strong) to Class 7 (very weak). Stronger corticosteroids are generally more effective in reducing moderate to severe symptoms, such as thick, chronic plaques, but are also more likely to cause side effects2. Lower strength corticosteroids are generally better for milder symptoms and for very sensitive areas of the body (such as the face or groin areas) and stronger strengths are better for areas with thicker skin (such as the knees and elbows).
What are the possible side effects of using topical corticosteroids?
While topical corticosteroids can be very effective in reducing symptoms for many people with psoriasis, they can cause some serious side effects. These include:
- thinning of the skin
- changes in skin color
- skin dryness
- skin irritation
- burning sensation
- easy bruising
- stretch marks
- skin redness
- widening (dilation) of the blood vessels
If topical corticosteroids are used on the face, it can cause side effects such as acne, redness, or swollen and visible blood vessels.
The risk of side effects is higher the stronger the corticosteroid is, and the longer the corticosteroid is used. For many people, the side effects will go away after stopping treatment with the corticosteroid, but for others, the effects may be long-lasting or even permanent. Your healthcare provider will monitor these side effects during the course of your treatment with corticosteroids.
These are not all the possible side effects of the corticosteroids. Patients should talk to their doctor about what to expect with treatment with any corticosteroids.
Long term use of topical corticosteroids
If a person uses a topical corticosteroid for a long time, then the medicine can eventually stop being as effective as it was before. People who completely stop treatment with a topical corticosteroid after using it for a longer period of time may also experience a rebound effect, in which psoriasis symptoms suddenly get much worse when treatment is stopped.
A strategy called pulse therapy or pulse dosing may be recommended to avoid these effects. In pulse therapy, patients apply the topical corticosteroid on a daily basis only until the symptoms improve, and then reduce the frequency of treatment to 2-3 days per week2.
Strong topical corticosteroids should never be applied on or around the eyelids because they can cause very serious conditions called glaucoma and cataracts to develop. Women who are pregnant or breastfeeding may be able to use certain types of corticosteroids, but will need to discuss it with their healthcare provider to make sure it is safe.
Can topical corticosteroids be used with other treatments?
Generally, topical corticosteroids are safe for use with other types of topical treatments for psoriasis, and in some cases can help to reduce the irritations that those treatments can cause3. Other topical treatments include:
In people with more severe psoriasis, topical corticosteroids may also be recommended for use with phototherapy and/or systemic medicines such as: