Although clinical guidelines for psoriasis treatment recommend against use of steroid treatment, results of a study suggest the medication is commonly prescribed for psoriasis.
Physicians in Germany and the United States frequently use systemic corticosteroids to treat psoriasis even though evidence-based guidelines do not include this medication as a treatment option, Steven R. Feldman, MD, PhD, and colleagues reported in Cutaneous Medicine and Surgery.
To assess how often prednisone, dexamethasone and methylprednisolone were prescribed for psoriasis, the researchers conducted a study tracking usage trends.
“Expert guidelines discourage [corticosteroid] use for psoriasis due to concerns about causing flares of generalized pustular psoriasis, but there are no randomized controlled trials of systemic corticosteroids in psoriasis to look at these issues,” study co-author Scott A. Davis, MS, said in a press release.
To determine the most commonly prescribed systemic medications for psoriasis from 1989 to 2010, researchers analyzed data from the National Ambulatory Medical Care Survey. They found that systemic corticosteroids were prescribed at 650,000 of 21 million physician visits for psoriasis.
Overall, corticosteroids were the second most commonly prescribed systemic medication for psoriasis, the researchers found.
When psoriasis was the sole diagnosis at a visit in which systemic corticosteroids were prescribed, the medication were prescribed alone or with topical corticosteroids at 95% of visits (95% CI: 86–100), without other systemic treatments to prevent rebound flare.
When psoriasis was not the only diagnosis during the visit, systemic corticosteroids were used without other systemic therapy in 92% (95% CI: 84–99) of systemic corticosteroid visits.
No significant increase or decrease in the use of systemic corticosteroids for psoriasis was observed during the study period (P=0.27).
Although new treatments are safe and effective and have been well studied, they are costly, noted researchers. Comparatively, corticosteroids have been available for decades, but have not been well studied for use in patients with psoriasis.
“The striking contrast between the guidelines for psoriasis management and actual practice suggests that there is an acute need to better understand the use of systemic corticosteroids for psoriasis,” the investigators concluded.