How to Use Steroid Cream for Psoriasis ?

Psoriasis is a chronic, inflammatory, multisystem disease which affects up to 3.2% of the U.S population. Topical steroids, which provide high efficacy and good safety, play a key role in the treatment of psoriasis, especially for localized disease. Topical Steroids have anti¬inflammatory, anti-proliferative, immunosuppressive, and vasoconstrictive effects. These effects are exerted via intracellular corticosteroid receptors, which regulate gene transcription, including several . that code for pro-inflammatory mediators. Topical corticosteroids are classified into 7 categories based on their skin vasoconstrictive activity, ranging in strength from ultra-high to low.

Choosing a Steroid with appropriate potency plus the appropriate vehicle should be based on the disease severity, disease location, patient preference, as well as the age of the patient. Lower potency corticosteroids should be used on the face, intertriginous areas, and areas that are susceptible to steroid atrophy (e.g. forearms) and other adverse effects. In adults, corticosteroids in classes 2 through 5 (moderate to high potency) are generally recommended as initial therapy. Areas with thick, chronic plaques often require treatment with Class 1 (ultra-high potency) corticosteroids. In numerous randomized controlled trials different potency topical corticosteroids were effective and safe at 2–4 weeks in the treatment of mild to severe plaque psoriasis. Evidence on topical corticosteroids’ efficacy from randomized controlled trials (RCT) varies due to the differences in study designs, patient populations, and endpoints, making it difficult to do an accurate statistical comparison of the majority of published studies.

For ultra-high potency (class 1) corticosteroids, the efficacy rates in several RCT vary from 58% to 92%. In a double-blind, vehicle-controlled trial of 204 patients with moderate to severe psoriasis, after 2 weeks of treatment, the halobetasol propionate ointment (Class 1) group improved the Physician’s Global Assessment (PGA) scores by 92% compared to 39% in vehicle-treated patients (P<0.0003).An RCT of 279 patients with mild to moderate psoriasis found that after 2 weeks of treatment with clobetasol foam (class 1), 68% of patients achieved a Physician’s Static Global Assessment (PSGA) score of 0 or 1 compared to 21% of patients treated with vehicle (P<0.0001).Another double-blind, RCT of 81 patients used the IGA scale to assess patients with mild to moderate psoriasis and demonstrated that after 2 weeks of treatment with clobetasol foam (class 1), 58% of patients achieved moderate or marked improvement, or almost or completely clear psoriasis as compared to 15% in vehicle- treated patients (P<0.0005).

For high potency (Class 2 and 3) corticosteroids, the efficacy rates in several RCTs vary from 68 to 74%. In a double blind-RCT of 35 patients with psoriasis treated with 0.25 % desoximetasone cream (Class 2) for 3 weeks, 68% of desoximetasone group compared to 23% of vehicle group achieved improvement in their mean overall evaluation scores (P<0.001).12 Two RCTs with fluticasone propionate 0.005%, a class 3 corticosteroid, showed 68% to 69% of moderate to severe psoriasis patients in the treatment group achieved, good, excellent, or clear skin after 4 weeks, as compared with 29% to 30% in the vehicle group (P=0.00001)

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