Topical steroids are anti-inflammatory medications that reduce skin inflammation in psoriasis. Topical steroid creams can help control the itch of psoriasis and decrease the thickness of the outer layer of the skin. Corticosteroids are the most commonly prescribed topical therapy for the management of psoriasis and are available in several forms, including ointments, creams, lotions, aerosols, or tapes (in the United States). An advantage of topical steroids is that they work relatively quickly and the cost is quite reasonable.
Steroid Potencies
Topical steroids range from low to high or ultra-high potency. Ointments are usually more potent than creams that contain the same concentration and type of steroid.
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| Skin Psoriasis Treatment |
In general, doctors may start psoriasis patients using low to mid-potency steroids. The strength and base (i.e., ointment or cream) of the steroid used may vary according to the site and the type of psoriasis lesions. For example, thick plaques of psoriasis on the elbows and knees may require higher potencies in an ointment form in order to penetrate the thick skin in these locations. Salicylic acid may be combined with the topical steroid as it reduces the scaling and can help increase steroid penetration. On the other hand, doctors generally like to use low-potency steroids in very sensitive areas where the skin is thin, such as in the genital region, the face (e.g., eyelids), and folds (crease between the buttocks, under the arms and breasts).
Most topical steroids are available by prescription only. Only milder topical steroids (e.g., hydrocortisone 0.5 percent) are available from the pharmacist without a prescription. Examples of some of the different types of corticosteroids that are available as creams, ointments, gels, foams, lotions, and solutions are listed below according to their potencies.
Class 1 Superpotent (ultra-high)
- Clobetasol I7-propionate (Dermovate) 0.05% (cream/ointment)
- Betamethasone dipropionate (Diprosone) 0.05% (ointment)
- Halobetasol propionate (Ultravate) 0.05% (cream/ointment)
- Betamethasone dipropionate 0,05% (cream)
- Mometasone furoate (Elocom) 0.1% (ointment)
- Fluocinonide (Lyderm; Tiamol; Lidex;) 0.05% (cream/ointment)
- Betamethasone dipropionate 0.05% (cream)
- Betamethasone valerate (Bataderm; Prevex B) 0.1% (ointment)
- Mometasone furoate 0.1% (cream)
- Betamethasone valerate 0.1% (cream)
- Fluocinolone acetonide (Synalar) 0.025% (cream)
- Betamethasone valerate 0.05% (cream)
- Desonide (Desocort) 0.05% (cream)
- Hydrocortisone (Cortoderm; Emo-Cort, Hycort, Hydrosone, Prevex HC) 0.5% and 1% (cream/ointment)
What Are the Possible Complications of Topical Steroids?
Steroids have been used extensively for long periods and are very safe when used appropriately. However, topical steroids can have certain side effects when they are either highly potent or used over long periods, and when used in more sensitive areas where the skin is thin.
The most common side effects reported with prolonged use of potent corticosteroids are stretch marks (striae) and thinning of the skin (atrophy). Both of these side effects occur with prolonged use of treatment (after at least one month of continual use), and tend to occur in areas where the skin is more sensitive or thin, especially the armpits and groin. Thinning of the skin is usually reversible if caught early and treatment is stopped. Stretch marks can also occur and are usually irreversible. Other side effects include:
- increased darkening of the skin (hyperpigmentation)
- increased lightening of the skin (hypopigmentation)
- ache (perioral acne)
- acne-like eruptions (rosacea)
- contact or irritant dermatitis
- easy bruising (purpura)
- inflammation of the hair follicle (folliculitis)
- increased blood vessel formation
- infection
- rebound of psoriasis (on stopping the treatment, usually abruptly)
- loss of response (tachyphylaxis)
Possible but rare side effects include:
- glaucoma (increased pressure in the eye)
- Cushing's syndrome (a hormonal disorder caused by prolonged exposure of the body's tissues to high levels of the hormone cortisol)
- decreased growth in children (very rare)
Never abruptly discontinue the use of potent topical steroids unless advised by your doctor or if you are having a reaction to the medication, or you might experience a rebound or flareup of psoriasis or a temporary worsening of the lesions.
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| Skin Psoriasis Treatment |
Some people might be unable to use topical steroids, particularly if they have any known allergy to corticosteroids or any component in it and/or any bacterial, fungal, or viral infections at the site of application.
In addition, topical steroids can lose their effect over time. This is termed "tachyphylaxis," meaning the body has developed a tolerance to the beneficial effects of the medication. To find out more, you can check out Skin Psoriasis Treatment.