One of the concerns with the use of systemic steroids for psoriasis is the development of pustular flares of the disease. Photo: James Graham Dermatopathology Collection at Wake Forest University School of Medicine.
The prescribing of systemic steroids for psoriasis is frowned upon in guidelines but is a common practice in the United States, finds Steven Feldman, M.D., Ph.D., a dermatologist and professor of dermatology, Wake Forest University, Winston-Salem, N.C.
Published in the Journal of Cutaneous Medicine and Surgery in February, the study used data from the National Ambulatory Medical Care Survey (NAMCS) to evaluate how frequently systemic steroids were prescribed to treat psoriasis, covering more than 20 years, from 1989 to 2010. The investigators found systemic corticosteroids were prescribed at an estimated 650,000 of 21 million psoriasis visits. Moreover, 93 percent of these visits were to dermatologists (J Cutan Med Surg. 2014;18:1-5).
To confirm their findings, investigators used a second source, MarketScan Medicaid. Data from that source demonstrated prednisone was prescribed to people with psoriasis more often than either methotrexate or the biologic agent etanercept. Moreover, use of systemic steroids for psoriasis has not been decreasing since the introduction of biologics for psoriasis.