Corticosteroids may not increase psoriasis flare rate

The rate of psoriasis flares did not increase during or immediately after systemic corticosteroid treatment, according to a study published in JAMA Dermatology.

“Dermatology textbooks and treatment guidelines recommend against systemic corticosteroid use in psoriasis patients because of risks of triggering severe psoriasis flares,” Anna R.F. Gregoire, MD, of the department of dermatology at Marshfield Clinic Health System in Wisconsin, and colleagues wrote.

This was supported by early literature concerning pustular psoriasis; however, more recent research has found no such connection.

The retrospective cohort study included 1,970 adult patients with psoriasis who had been prescribed at least one systemic corticosteroid between 2012 and 2018.

There was an overall psoriasis flare rate of 1.42% (95% CI, 0.72%-2.44%) and a calculated severe flare rate of 0.07% (95% CI, 0%-0.26%).

In 516 manually abstracted patients, 16 flares were identified. Worsening plaque psoriasis was experienced in 15 patients who had flaring.

“This study’s results suggest that psoriasis flare rates for patients taking or finishing systemic corticosteroid courses is very low and predominately associated with mild flaring,” the authors wrote. “While we are not advocating systemic steroids to treat psoriasis, we challenge the notion that steroids induce severe psoriasis flares at significant rates in a general psoriasis population.”