What to know about steroid creams and psoriasis

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Steroid creams are topical corticosteroids, which are anti-inflammatory preparations that can help manage skin conditions. These medications can mimic the effects of hormones to reduce inflammation and suppress overactive immune system responses.

Creams are one of the formulations that people can use to deliver steroids to the skin. In comparison with ointments, creams have less oil and more water content. Other topical formulations include lotions, sprays, gels, powders, and foams.

Topical steroids receive a grading that describes their potency. Stronger formulations are more potent, so they may be more effective, but they are more likely to result in adverse effects. The National Psoriasis Foundation has a chart that lists topical steroids according to their strength and includes the brand and generic names of the drugs.

Psoriasis is a skin condition that results from an overactive and inappropriate immune system response to a trigger. This response causes inflammation and makes the skin regenerate faster, leading to the characteristic silvery scales and discolored patches on the skin.

Steroid creams have many functions that make them effective in treating skin problems such as psoriasis. Primarily, they suppress the body’s response to inflammation, which reduces itching and discoloration.

Cortical steroids are typically the first-line treatment option for managing all severities and types of psoriasis, whether alone or in combination with other therapies. Research showed that 45% of people experienced a significant improvement in their psoriasis within a few weeks of using high potency corticosteroids compared with 10% of individuals who received a placebo.

However, the effectiveness of using topical steroids varies depending on several factors. These include:

Proper dosage

Insufficient steroid application might cause a lack of response, while overapplication may increase the side effects. Doctors may instruct individuals to avoid these issues by using the fingertip unit (FTU) method, which refers to using the distance between the last finger crease and the fingertip to measure the amount of cream that a person uses.

Area

In relation to proper dosage, areas with thinner skin, such as the eyelids and face, absorb topical steroids more easily than areas with thicker skin, such as the soles of the feet. Individuals may also need to apply more medication to psoriatic skin lesions.

However, people should take care when applying steroids to areas where two skin surfaces touch or rub, such as the armpits and the area under the breasts. It is advisable to use creams sparingly in these areas because the absorption of the drug might be higher, and there is a risk of bacteria or yeast growing.

Potency

The drug’s effectiveness also depends on its strength. However, doctors will likely only provide potent and very potent steroids for short-term use to avoid side effects.

Adherence

For the best results, a person will need to use the steroid cream regularly and correctly. A 2020 study notes that psoriasis with apparent resistance to treatment is often due to poor adherence to treatment schedules.

Type of preparation

Research has shown that the skin absorbs steroids more easily from ointments than from other topical forms, such as creams or lotions. Ointments are also the most effective form of the medication because of their ability to prevent moisture loss.

However, the vehicle or formulation that a person uses will depend on the affected body area. Individuals with moist, weepy lesions will benefit more from creams, while those with dry lesions will generally get better results using ointments.

Side effects are rare when a person uses corticosteroids correctly and for a limited time. A 2021 study states that the potential of developing side effects depends on the vehicle, application site, and drug strength.

Possible side effects may include:

• skin thinning
• stretch marks
• bruising
• enlarged blood vessels
• thicker hair
• pustular psoriasis
• steroid-induced rosacea
• dermatitis
• stinging
• cataracts
• glaucoma
• Cushing’s disease

The excessive use of high potency steroids can result in the systemic absorption of these drugs, which can lead to hyperglycemia and hypertension.

Due to the effect that topical steroids have on the immune system, they can have substantial effects on the body and may not be advisable for some people. For example, they may not be suitable for people with the following conditions:

• diabetes
• high blood pressure
• current infections
• heart problems
• mental health illness
• osteoporosis
• peptic ulcer disease

A 2021 article notes that they are safe for those who are pregnant and breastfeeding. However, as corticosteroid use carries risks, doctors may avoid prescribing these medications to individuals who are pregnant when possible.

A person should also discuss any recent vaccinations or other current medications they are taking with their doctor to avoid any potential interactions.

People should carefully follow their prescriber’s instructions regarding the use and treatment schedule of steroid creams. Doctors may provide the creams in different formulations depending on the affected area.

Typically, a doctor will advise applying the cream to inflamed skin over the course of a few days or weeks. Under their doctor’s guidance, a person may then stop using the steroid cream, use a less potent formulation, or apply the cream less frequently.

People should only spread a thin layer of steroid cream on the affected areas following the FTU method. It is not advisable to use steroid creams for more than several weeks or to discontinue them abruptly unless a doctor has advised doing so.

Depending on the severity of a person’s psoriasis symptoms and their response to treatment, a doctor may provide them with a range of treatment options. These can include:

• Other topicals: A treatment plan might include nonsteroidal topicals and over-the-counter topicals, such as lotions and emollients.
• Systemics: Doctors typically prescribe these drugs to people with moderate-to-severe psoriasis. Individuals take them by mouth or through infusion or injection.
• Phototherapy: Also called light therapy, phototherapy uses UV light to treat localized psoriatic plaques.
• Alternative treatments: These include natural remedies, such as aloe vera, tea tree oil, and capsaicin, which have properties that can help improve symptoms. People can also explore yoga and alternative medical systems, which include traditional Chinese medicine and Ayurveda.

Psoriasis is a chronic condition that causes the body to produce skin cells at an increased rate, resulting in the characteristic psoriatic plaques. Topical steroids, such as steroid creams, are a common form of treatment for all types of psoriasis. They help by suppressing inflammation, which reduces symptoms. Individuals need to take care when using steroid creams, as improper use is associated with various side effects.