Is a single dose of injectable (inj) dexamethasone safe in a patient with psoriasis presenting with diarrhea, vomiting, and abdominal pain?

Single Dose Injectable Dexamethasone in Psoriasis with Gastrointestinal Symptoms

A single dose of injectable dexamethasone should be avoided in patients with psoriasis presenting with diarrhea, vomiting, and abdominal pain due to the risk of disease exacerbation upon steroid withdrawal. 1

Risks of Systemic Corticosteroids in Psoriasis

• Systemic corticosteroids, including injectable dexamethasone, are contraindicated in psoriasis as they can precipitate erythrodermic psoriasis, generalized pustular psoriasis, or unstable psoriasis, particularly when discontinued 1
• Despite their widespread use, systemic steroids are not recommended by dermatological guidelines for psoriasis management due to the risk of disease deterioration after dose reduction or withdrawal 2
• The rebound phenomenon can be more severe than the initial presentation, potentially leading to life-threatening forms of psoriasis 1, 2

Management of Gastrointestinal Symptoms in Psoriasis

• The gastrointestinal symptoms (diarrhea, vomiting, abdominal pain) may be related to:

  • Medications used for psoriasis treatment (e.g., leflunomide, MMF) 3
  • Unrelated gastrointestinal infection or condition 1

• For managing gastrointestinal symptoms in psoriasis patients:

  • Identify and address the underlying cause of gastrointestinal symptoms rather than masking with corticosteroids 1
  • Consider temporary discontinuation of psoriasis medications that may cause gastrointestinal side effects 3
  • Provide symptomatic treatment for gastrointestinal symptoms with anti-emetics, anti-diarrheals, or hydration as appropriate 1

Alternative Approaches for Acute Psoriasis Management

• For acute management of psoriasis flares, consider:
  • Topical treatments: Medium-to-high potency topical corticosteroids for localized disease 4, 5
  • Phototherapy: Narrowband UVB as first-line phototherapy with fewer side effects than PUVA 4
  • Systemic agents: Acitretin, methotrexate, or cyclosporine for moderate-to-severe disease 4, 1

Special Considerations for Psoriasis with Gastrointestinal Symptoms

• Evaluate for drug interactions between psoriasis medications and any treatments for gastrointestinal symptoms 3
• Monitor for dehydration and electrolyte imbalances due to diarrhea and vomiting 1
• Consider dermatology consultation for management planning, especially if the patient's psoriasis is unstable 1

Important Caveats

• If systemic corticosteroids have already been administered, implement a gradual tapering schedule over several weeks to minimize withdrawal effects 1
• Monitor closely during any tapering period for signs of worsening psoriasis 1
• The risk-benefit ratio for a single dose of injectable dexamethasone is unfavorable in psoriasis patients, even for acute symptom management 1, 2