(Examples: betamethasone, hydrocortisone, etc.)
What it does / How it works
Corticosteroids are synthetic versions of hormones made in the body and are the most commonly prescribed medications for psoriasis flares. When applied to the skin, topical corticosteroids reduce inflammation, making them useful for psoriasis. Their potency can range from low to very high (see table below for classification of common topical corticosteroid therapies). The dosage form and potency are usually selected based on the severity of disease, which area is affected, and patient preference. Lower potency corticosteroids are best for sensitive areas such as the face, groin, armpits, backs of knees, and the inside of elbows. Areas with thick or widespread plaques may require higher potency corticosteroids.
Patients may begin to see improvement 1 or 2 weeks after starting treatment with an appropriate corticosteroid. Use of these medications is often limited to a course of 2 to 4 weeks at a time to reduce side effects.
Topical corticosteroids are available in a variety of formulations including creams, lotions, foams, gels, ointments, sprays, and shampoos.
Dose and frequency
Topical corticosteroids are usually applied to the affected areas once or twice a day. After psoriasis symptoms resolve, the medication is gradually reduced by changing to a lower potency corticosteroid or by reducing the frequency of use. It is important to follow the doctor’s specific instructions to prevent rebound outbreaks after stopping therapy.
Potential side effects
With extensive, non-supervised, and prolonged use of high potency topical steroids, over a large surface area you may notice side effects such as :
- Fragile, thin skin
- Easy bruising
- Noticeable small blood vessels on your skin
- Bands of thin, red skin that fade to pale streaks (stretch marks)
- Infection of hair follicles
- Tiny red or purple spots
- Hair growth on the sites of application
Topical corticosteroids can worsen rosacea, perioral dermatitis, athlete’s foot and similar infections. If high-dose corticosteroids are used over a large area for over 3-18 months[REF], it’s possible for rare systemic side effects to appear such as Cushing’s syndrome, cataracts, glaucoma or osteoporosis. It is important to follow any instructions your doctor gives you about using a topical corticosteroid. Talk with your dermatologist or healthcare provider before bandaging over corticosteroids as occlusive dressings can increase absorption of the medication and increase the risk of side effects.
How to manage side effects
Talk to your doctor or pharmacist if you suspect you are experiencing medication side effects.
Other topical therapies such as vitamin D analogues, topical retinoids, and calcineurin inhibitors can be used long-term to reduce the recurrence of psoriasis after the discontinuation of topical corticosteroids. These treatments are sometimes referred to as steroid-sparing agents because they can reduce the need for topical corticosteroids which can help to limit steroid-related side effects. There is some controversy over whether people can develop a resistance to topical corticosteroids over time.
Some topical corticosteroid treatments are available as generics. Generic medications are just as effective and safe as the brand name medication but are less expensive.
Corticosteroid Potency Table
(This is not an exhaustive list)
REFERENCE: Joint AAD–NPF Guidelines of care for the management and treatment of psoriasis with topical therapy and alternative medicine modalities for psoriasis severity measures, Crossref DOI link: https://doi.org/10.1016/J.JAAD.2020.07.087, Published: 2021-02
Clobetasol propionate 0.05%
Halobetasol propionate 0.05%
Mometasone furoate 0.1%
Triamcinolone acetonide 0.5%
Mometasone furoate 0.1%
Triamcinolone acetonide 0.1%
Betamethasone valerate 0.1%
Betamethasone dipropionate 0.05%
Triamcinolone acetonide 0.01%
Betamethasone valerate 0.05%