Are Systemic Corticosteroids Causing Psoriasis Flare-Ups? Questionnaire for Danish Dermatologists, Gastroenterologists and Rheumatologists

Abstract

<b><i>Background:</i></b> Psoriasis flare-ups and the change of morphology from nonpustular to pustular psoriasis following tapering and withdrawal of systemic corticosteroids have been reported. Despite these risks, systemic corticosteroids are still widely prescribed for patients with psoriasis, but the knowledge about psoriasis flare-ups and whether the physicians take precautions during these treatments is limited. <b><i>Methods:</i></b> We conducted a questionnaire study among all dermatologists, gastroenterologists and rheumatologists in Denmark who work at a hospital or in a private practice to investigate the use, opinion and experience with oral, intramuscular and intra-articular corticosteroids in the treatment of patients with psoriasis. <b><i>Results:</i></b> We received answers from a total of 248 physicians. Compared with oral and intramuscular corticosteroids, intra-articular corticosteroids were the most reported treatment in patients with psoriasis and only used by the rheumatologists. It was mainly the dermatologists and rheumatologists who had observed psoriasis flare-ups following treatment with oral, intramuscular and intra-articular corticosteroids. Half of the dermatologists (50%) and a fourth of the rheumatologists (29%) had observed at least one psoriasis flare-up following treatment with oral corticosteroids. About 10% of both the dermatologists and the rheumatologists had observed at least one psoriasis flare-up following treatment with intramuscular and/or intra-articular corticosteroids. Overall, 44% of the respondents took precautions, when they treated a patient with psoriasis with oral, intramuscular and intra-articular corticosteroids. <b><i>Conclusion:</i></b> The results from the questionnaire indicate that systemic corticosteroids for patients with psoriasis can cause flare-ups and should be used with care.

New Onset and Exacerbations of Psoriasis Following COVID-19 Vaccines: A Systematic Review

“…Although the avoidance of systemic corticosteroids is typically recommended in the treatment of psoriasis vulgaris due to the possibility of rebound phenomenon, a recent meta-analysis questioned this commonly propagated belief and found low rates of rebound flares [ 83 ]. Generally, a gradual tapering of systemic corticosteroids was recommended for psoriatic patients [ 84 ]. In our study, systemic corticosteroids were administered in eight cases during the acute phase of psoriasis (including plaque, palmoplantar pustulosis, severe pustular, generalized pustular, and erythrodermic psoriasis and PsA) [ 11 , 38 , 44 , 52 , 61 ].…”

Systemische Behandlung von Patienten mit Psoriasis in der täglichen Praxis: Eine retrospektive Studie auf Basis deutscher Krankenkassendaten

“…Ein erheblicher Teil dieser Patienten wurde mit systemischen Kortikosteroiden behandelt (8,7%). Eine Therapie mit systemischen Kortikosteroiden ist mit Risiken verbunden, kann sogar Schübe auslösen oder eine pustulöse Psoriasis verursachen, 34,35 und steht nicht im Einklang mit den Empfehlungen der nationalen und internationalen PSO‐Behandlungsleitlinien 14–18 . Die häufige Verwendung von Kortikosteroiden ist bereits aus früheren Veröffentlichungen bekannt, und unsere aktuellen Ergebnisse unterstreichen die Notwendigkeit, die Behandlungsalgorithmen in der Praxis zu verbessern 1,7,36,37 …”

Psoriasis flares and rebound phenomenon following exposure and withdrawal of systemic steroids: A systematic review and meta-analysis

“…A survey of dermatologists and rheumatologists found that 47% had observed at least 1 psoriasis flare following treatment with oral steroids. 4 The reasons for the discrepancies include attribution bias and difficulty differentiating an expected recurrence of the dermatosis from a true rebound phenomenon. Finally, the risk of flares may differ depending on the underlying disease (eg, higher risk in patients with GPP).…”

“…We defined our inclusion criteria for suboptimal healing conditions as follows: patients aged [65 years with at least 1 comorbidity associated with poor wound healing (diabetes mellitus, cardiovascular disease, peripheral vascular disease, venous insufficiency, and smoking). 1,3,4 We routinely manage patients with wounds in the lower portion of the leg that heal by a secondary intention after Mohs micrographic surgery with petroleum jelly and a nonadherent dressing. Starting in January 2020, we began supplementing standard care with topical 0.5% timolol maleate ophthalmic solution (1 or 2 drops per day on wounds of #2 cm or [2 cm, respectively) for patients with suboptimal healing conditions.…”