From the Guidelines
Oral prednisolone is generally not advised for treating psoriasis due to the high risk of rebound flares and significant side effects associated with its long-term use. While oral corticosteroids like prednisolone can provide rapid relief of psoriasis symptoms, their use is discouraged as it can lead to rebounds that are often more severe than the original outbreak 1. Additionally, long-term use of oral corticosteroids carries significant side effects including weight gain, hypertension, diabetes, osteoporosis, and increased susceptibility to infections.
For psoriasis management, preferred treatments include:
- Topical therapies (corticosteroids, vitamin D analogs, retinoids)
- Phototherapy
- Systemic medications such as methotrexate, cyclosporine, biologics, or oral retinoids These alternatives provide better long-term control without the rebound risk associated with oral corticosteroids 1. It is recommended that patients who are not infected with SARS-CoV-2 continue their biologic or oral therapies for psoriasis and/or psoriatic arthritis in most cases, with shared decision making between clinician and patient 1.
If a patient is currently taking oral prednisolone for psoriasis, they should not stop abruptly but should consult their dermatologist about transitioning to more appropriate long-term treatment options. Chronic systemic corticosteroids should be avoided if possible for the management of psoriatic arthritis, and the dose should be tapered to the lowest dose necessary to achieve the desired therapeutic effect if they are required 1.
From the FDA Drug Label
Dermatologic Diseases: Pemphigus; bullous dermatitis herpetiformis; severe erythema multiforme (Stevens-Johnson syndrome); exfoliative erythroderma; mycosis fungoides. Rheumatic Disorders: As adjunctive therapy for short term administration (to tide the patient over an acute episode or exacerbation) in: psoriatic arthritis;
The use of oral prednisolone is advised for psoriatic arthritis, which is a condition related to psoriasis. However, the label does not explicitly mention the use of oral prednisolone for treating psoriasis itself. Therefore, based on the provided information, it can be said that oral prednisolone is not directly advised for treating psoriasis, but it is advised for a related condition, psoriatic arthritis 2.
From the Research
Oral Prednisolone in Psoriasis Treatment
- The use of systemic steroids, such as oral prednisolone, in the treatment of psoriasis is not recommended by dermatological textbooks and guidelines due to the risk of disease deterioration after dose reduction or withdrawal 3.
- A study found that systemic steroids were the most frequently prescribed drugs for psoriasis by general practitioners, internal medicine physicians, and dermatologists, despite the reported adverse effects 3.
- There is a lack of literature addressing the adverse effects of systemic steroids in psoriasis, such as rebound, pustular, or erythrodermic flares, or even new occurrence of psoriasis in patients with a negative disease history 3.
- Topical corticosteroids are considered a first-line treatment for psoriasis, and oral prednisolone is not typically recommended as a first-line treatment 4, 5, 6.
- Topical vitamin D analogs are also considered a first-line treatment for psoriasis and may be used in combination with topical corticosteroids, providing a "steroid-sparing" effect and a favorable safety profile 4, 6.
Alternative Treatments
- Topical vitamin D analogs and topical corticosteroids are considered effective treatments for plaque psoriasis, but it is still not clear which would be the best alternative 7.
- A meta-analysis found that there might be little or no difference in clinical response between topical corticosteroids and topical vitamin D analogues, but topical corticosteroids are less irritating at the site of application 7.
- No studies evaluating the long-term adverse effects of topical corticosteroids and topical vitamin D analogues were found 7.
Considerations
- The treatment of psoriasis should be individualized, taking into account the severity of the disease, the patient's medical history, and the potential risks and benefits of each treatment option.
- Further research is needed to inform long-term maintenance treatment and provide appropriate safety data for patients with chronic plaque psoriasis receiving long-term treatment with corticosteroids 5.