From the Guidelines
Topical corticosteroids are a highly effective treatment for both psoriasis and eczema, with the most recent evidence suggesting that ultra-high potency corticosteroids, such as clobetasol propionate, can achieve efficacy rates of up to 92% in the treatment of moderate to severe psoriasis 1.
Key Considerations for Treatment
When treating psoriasis and eczema with topical corticosteroids, several factors must be considered, including:
- Disease severity: More severe cases may require higher potency corticosteroids, such as class 1 (ultra-high potency) agents like clobetasol propionate or halobetasol propionate 1.
- Disease location: Sensitive areas, such as the face, genitals, and skin folds, may require lower potency corticosteroids to minimize the risk of adverse effects 1.
- Patient preference and age: Older patients or those with sensitive skin may require lower potency corticosteroids or alternative treatments 1.
Treatment Recommendations
For mild to moderate eczema, start with low-potency steroids like hydrocortisone 1% for sensitive areas and medium-potency options like triamcinolone 0.1% for the body, applying a thin layer twice daily for 1-2 weeks. For psoriasis, medium to high-potency steroids like betamethasone valerate 0.1% or clobetasol 0.05% are typically needed, applied twice daily for 2-4 weeks 1. Use the fingertip unit method for proper dosing and apply after bathing when skin is slightly damp, and use moisturizers regularly.
Side Effects and Maintenance
Side effects of topical corticosteroids include skin thinning, stretch marks, and increased infection risk, so follow a treatment schedule with breaks between courses for chronic conditions 1. For maintenance, consider using steroids just 2-3 times weekly or switching to non-steroidal alternatives like tacrolimus or pimecrolimus for sensitive areas. Steroids work by reducing inflammation, decreasing cell turnover, and suppressing immune responses in the skin. The most recent evidence suggests that topical corticosteroids can be used safely and effectively for up to 4 weeks, with some studies demonstrating efficacy and safety for up to 2-4 weeks 1.
From the FDA Drug Label
CLINICAL PHARMACOLOGY Topical corticosteroids share anti-inflammatory, antipruritic and vasoconstrictive actions. The topical corticosteroids, such as triamcinolone, are used for their anti-inflammatory and antipruritic properties.
- They can be used to treat psoriasis and eczema due to these properties.
- The mechanism of action is not fully understood, but they are effective in reducing inflammation and itching associated with these conditions 2.
From the Research
Topical Steroids for Psoriasis
- Topical steroids are a first-line treatment for moderate-to-severe plaque psoriasis, often used in combination with other treatments such as vitamin D analogs and topical calcineurin inhibitors 3.
- The combination of potent and superpotent corticosteroids with vitamin D analogues has been shown to provide an improvement in psoriasis within 2 weeks, reaching a maximal improvement after 4 weeks in the majority of patients 4.
- Topical corticosteroids and vitamin D analogues remain the most commonly used and widely available topical treatments for psoriasis, with evidence for efficacy and safety readily available for short-term treatment with corticosteroids 5.
Efficacy and Safety of Topical Steroids
- Studies have shown that topical steroids can be effective in treating mild-to-moderate plaque psoriasis, with 30-90% of patients experiencing more than 50% improvement in initial psoriasis severity 6.
- The success rate of topical steroids in treating scalp psoriasis has been reported to be between 40% to 75% of patients experiencing more than 75% improvement in initial scalp psoriasis severity 6.
- Maintenance intermittent treatment with topical steroids has been shown to be useful in prolonging remission in patients with psoriasis 6.
Comparison with Other Treatments
- Biologics are a safe and effective treatment option for psoriasis, but patients often prefer oral therapy over injectable medications, and anti-drug antibodies can reduce their effectiveness over time 3.
- Oral medications are preferred by some patients, but the cost can be a barrier, and new synthetic treatment options are being developed to address this issue 3.
- Novel topical agents such as tapinarof and roflumilast have been proven effective in randomized controlled trials for psoriasis, but their use may be limited by cost 7.