Using Topical Corticosteroids for Psoriasis

Applying cream

There are seven different categories of topical corticosteroids based upon strength. The mildest of these, class 7, includes over-the-counter hydrocortisone 1 percent. The strongest, class 1, consist of the "big gun" steroid creams such as clobetasol.

Topical Corticosteroids and Psoriasis

Topical corticosteroids offer a variety of benefits if you have psoriasis. Unlike oral medications, you can apply these treatments right on your skin, so the medicine goes directly to the affected area. These topical medications help your psoriasis by:

  • Reducing inflammation
  • Increasing the rate of skin cell renewal
  • Suppressing your overactive immune system
  • Helping your skin peel and unclogging your pores
  • Soothing your skin

Types of Topical Corticosteroids

Not all topical corticosteroids are the same. Your doctor will prescribe the option that is best for you, but here are some the different choices available: 

  • Ointments. A type of topical corticosteroid made from a petrolatum-based "grease."
  • Creams. These are lighter and less greasy than ointments and much nicer to use on your face, groin, and armpits.
  • Oils. Can be used for whole-body treatment or overnight scalp treatment.
  • Gels. These aren't greasy and completely absorb into your skin, making them great for hairy areas. 
  • Foams. Easy to spread and are also good for your scalp and hairy areas.
  • Tapes. Appropriate for thicker plaques such as the ones frequently seen on the elbows and knees. 

Ointments are typically more potent than creams but are also messier. Foams are very effective in that they tend to penetrate to deeper layers of the skin than other vehicles. Hence, a slightly less potent active ingredient may give more benefit if delivered in a foam.

Finding the Right Topical Corticosteroid

Which topic corticosteroid is right for you depends on a number of variables including your age, where your psoriasis is located and the amount of body surface that needs treatment. With so many products and classes of corticosteroids, your doctor will choose your prescription carefully. In an attempt to avoid side effects, they will usually try to use the least potent steroid to get the job done.

Side Effects of Corticosteroids

Class 1 steroids are not just a little stronger than class 7, they are exponentially stronger. These ultra-high-potency preparations have the greatest efficacy and side effects. A typical prescription only lasts two to three weeks.

There are a number of side effects you should be aware of if you take topical corticosteroids. Strong steroids can damage your eyes and lead to glaucoma and cataracts. Using a too-strong steroid on your face can also lead to acne, rosacea, and the development of little red blood vessels called telangiectasia.

If you use topical corticosteroids on your groin and armpits, stronger classes of steroid can cause large red stretch marks to develop. These are usually permanent. Continuous use of strong steroids on the same exact areas leads can cause your skin to thin, which can also be permanent. Lastly, covering large areas of your body with potent steroid creams can lead to systemic absorption and loss of the body's ability to make its own natural cortisol. 

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Article Sources
  • National Institute of Arthritis and Musculoskeletal and Skin Diseases: What Is Psoriasis? Fast Facts - An Easy-to-Read Series of Publications for the Public
  • World Health Organization: Classification of Topical Corticosteroids