Steroids for psoriasis

Steroids for psoriasis! What do steroids actually do?

Steroids are essentially hormones, and there are many different types with quite different actions. The human body makes its own steroids in the adrenal glands, and these are vital for the body’s normal function.

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Different types of synthetic steroid have been developed for use in medicine. There is a group called anabolic steroids, which some athletes take (illegally!) to help build up muscle mass, and these should not be confused with the steroids used in psoriasis. These belong to another group called catabolic steroids or glucocorticoids (e.g. prednisolone), which are taken orally (by mouth) because of their anti-inflammatory and immunosuppressive properties – they damp down the activity of various immune cells in the body that cause inflammation. They are very useful, even life-saving, in some medical conditions such as severe asthma or rheumatoid arthritis. The downside of this group of steroids is that if they are used at a high dose for a prolonged period, they have many side-effects such as weight gain, bone thinning, decreased growth in children, high blood pressure and loss of muscle mass, to name but a few. Because of this, doctors try to use these steroids at the lowest possible dose for short periods. This type of oral steroid is used very occasionally in the treatment of a very severe flare-up of psoriasis. However, for the reasons already mentioned, they are normally used for only a few weeks, the starting dose being gradually decreased over this period of time. This method should prevent or minimise any serious side-effects.

Fortunately, these anti-inflammatory steroids can also be mad into creams for topical application directly on to the skin (topical steroids). They act in a fashion similar to that of their oral counterparts. These creams have been developed to try to produce the same anti-inflammatory properties without all the side-effects on the rest of the body, even after long-term use. This approach has been very successful, and topical steroids are useful for psoriasis in certain circumstances such as on the scalp and in the flexures, or if the psoriasis is very inflamed.

This is an extremely common question and worry for many people. We are not entirely sure why so much misinformation has been generated about topical steroids, but people do seem to have extremely strong views about their safety. The following points may in part explain why some of the myths have developed:

• The very earliest topical steroids developed were poorly regulated and of uncertain strength (potency). Even as late as the early 1980s, there was little recognition of the potential danger of an excessive use of the potent steroids, so there were unwanted and undesirable side-effects.These included skin thinning if used on skin other than the  palms and soles for more than a few weeks. Unfortunately, when this side-effect was noticed, topical steroids got a bad name. This bad publicity has regrettably been inappropriately extended by some people to all steroids, even the very weak ones. Remember that topical steroids vary enormously in strength.

Steroids taken by mouth have a number of side-effects, and many people assume that topical steroids do as well. This is not true. Topical steroids were developed specifically to prevent the problems of oral steroids.

• There are different types of steroid, which act differently and have different side-effects. It is easy to assume that all steroids are the same and thus misunderstand the sideeffect risks. For example, anabolic steroids can cause an increase in muscle size and liver damage but this does not occur with the topical steroids used in psoriasis. Anabolic steroids are not available as creams, so there is no chance of being given the wrong type.

• Many people have become disillusioned with conventional medicine. There has been a social trend to assume that Western medicines are dangerous and that herbal remedies or natural products are safe and preferable. The word ‘steroid’ has become almost synonymous with all that is bad about conventional medical treatments.

• Steroids do not cure psoriasis, so it often recurs after using them and can ‘rebound’ (come back) and become worse. You may have expected a cure – partly because the media love reporting on ‘miracle cures’ – and might be reluctant to use them again.