Systemic Steroids Seldom Flare Psoriasis Save

A tenet of drug management suggests that steroid use in psoriasis may be associated with rebound flares; well this has been challenged by a new observational trial showing that the risk of flares (and severe flares) of psoriasis flares were seldom triggered by systemic steroids - certainly much less than what is traditionally taught in dermatology

This observational cohort study of 1970 psoriasis (PSO) patients assessed the rate of psoriasis flare during or within 3 months following the systemic corticosteroid use.  Excluded were patients with psoriatic arthritis and those receiving only topical, intraarticular, or intrabursal corticosteroids.

Among 1970 PSO patients, systemic corticosteroids were temporily associated with PSO flare rate in 1.42% (95% CI, 0.72%-2.44%) of patients. Only 1 severe flare (of erythroderma) was reported, and there were no pustular psoriasis flares identified (0.07%; 95% CI, 0.00%-0.26%).

Thus, the rates of steroid related PSO flares were very low, and the rates of severe PSO flares, including erythrodermic and pustular psoriasis, were extremely low. Of the few flares that occurred, these appeared to be unlikely association with systemic corticosteroids.