Dermatologists prescribe steroids for psoriasis management, despite guidelines that discourage use

Researchers at The Center for Dermatology Research at Wake Forest Baptist assessed how often these drugs -- prednisone, dexamethasone and methylprednisolone -- were prescribed and trends in their use over time.

"Expert guidelines discourage their 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," said Scott A. Davis, M.S., a co-author of the study and assistant director of the Center for Dermatology Research at Wake Forest Baptist Medical Center.

Davis and colleagues used National Ambulatory Medical Care Survey data to determine the systemic medications prescribed for psoriasis from 1989 to 2010. They found that systemic corticosteroids were prescribed at 650,000 of 21 million psoriasis visits. Of these prescriptions, 93 percent were from dermatologists. Corticosteroids were the second most commonly prescribed systemic medication for psoriasis, according to the study which appears online this month ahead of print in the Journal of Cutaneous Medicine and Surgery.

Despite the warnings and concerns, the drugs are widely used, the study showed. "Psoriasis has an enormous impact on patients' lives, and there have been major recent advances in treatment," Davis said. "While the new treatments are highly effective and appear very safe, they are costly; their effects are well studied. In contrast, while corticosteroids have been available for decades, their use in psoriasis has not been extensively studied."