From the Guidelines
Prednisone can be effective for treating acute psoriasis flares, but it is not considered a first-line or long-term treatment option due to its potential for severe side effects and rebound flares. For severe or rapidly progressing psoriasis, oral prednisone may be prescribed at doses of 0.5-0.75 mg/kg per day for a short course, with a gradual taper to prevent rebound flares, as suggested by the European Dermatology Forum consensus 1. The medication works by reducing inflammation and suppressing immune system activity that contributes to psoriasis plaques. However, systemic corticosteroids like prednisone come with significant risks including diabetes, hypertension, osteoporosis, and adrenal suppression when used long-term. More concerning is the potential for severe rebound flares when the medication is discontinued, which can sometimes result in pustular or erythrodermic psoriasis that is more severe than the original outbreak.
Some key points to consider when using prednisone for acute psoriasis include:
- Starting with a low dose of 0.5-0.75 mg/kg per day and tapering as needed to minimize side effects 1
- Using prednisone as a bridge therapy while initiating other more appropriate long-term treatments for psoriasis
- Monitoring patients closely for signs of rebound flares or other adverse effects
- Considering alternative treatments such as topical therapies, phototherapy, or biologics for managing psoriasis, as they may have a more favorable risk-benefit profile.
It's worth noting that older guidelines, such as those from 1991, may not reflect the current standard of care for psoriasis management 1. Therefore, it's essential to rely on the most recent and highest-quality evidence when making treatment decisions. In this case, the European Dermatology Forum consensus provides more relevant and up-to-date guidance on the use of prednisone for acute psoriasis 1.
From the Research
Efficacy of Prednisone for Acute Psoriasis
- There are no direct studies provided that assess the efficacy of prednisone for acute psoriasis.
- However, studies have investigated the use of systemic steroids in psoriasis treatment, highlighting the risk of disease deterioration after dose reduction or withdrawal 2.
- The use of systemic steroids, including prednisone, is not recommended by dermatological textbooks and guidelines due to potential adverse effects 2.
- A study on topical corticosteroids in plaque psoriasis found that maintenance intermittent treatment appears to be useful to prolong remission, but the evidence is not directly applicable to prednisone or acute psoriasis 3.
- Other studies have focused on the combination of methotrexate and narrowband UVB phototherapy for chronic plaque-type psoriasis, showing rapid clinical improvement compared to monotherapy 4, 5, 6.