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Psoriasis - Steroid Side Effects

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Steroid Side Effects

Since steroids are such a commonly-used treatment in psoriasis, its important to understand that though they provide an immediate relief, but at a cost of long as well as short term side effects which can be crippling. Actually, we are not going to really discuss the burning, itching, inflammation or other similar side effects, as they are the most common, and also, it seems to us, the least worrisome.
The most important and long term side effects include

Softening or Thinning of the Skin, Stretch Marks

Prolonged use of strong steroidal creams or lotions may lead to skin thinning or softening.However, while thinned skin may regain its usual thickness some time after termination of the drugs, stretch marks may be tougher to get rid of.

HPA Axis Suppression

Topically-applied steroids get absorbed into the skin, and are also absorbed into the blood stream. If too much gets absorbed, it will “mislead or fool” the HPA Axis(Hypothalamus-pitutary-adrenal) into thinking the body is producing too many steroids. The production of steroids will be reduced accordingly. This will lead to the problem of “rebound,” but can also cause other problems


One function of steroids in the body is to regulate the amount of inflammation in an immune response. This is why topically-applied steroids reduce psoriasis symptoms, the “extra” steroids in the skin signal the immune system to reduce or shut down the inflammatory response.

For the most part, rebound occurs because of HPA Axis Suppression and a sudden termination of steroids. Once the HPA Axis is making steroids at a lower level due to systemic absorption of topical steroids, stopping the “extra” steroids too quickly will leave the body with a large deficit in these inflammation-controlling substances. The immune system can then “run wild,” and a large flare-up of psoriasis may be possible

So, if a person has been using large amounts of topical steroids (in the case of Class I steroids, more than seven grams a day, typically), or for a long period of time (more than two weeks for the strong ones), it is a good precaution to “wean” the body off steroids, by dropping the dosage slowly. A dermatologist will be able to suggest a schedule for doing so, depending on the length of time and strength of the drugs

Cushing’s Syndrome

Cushing’s syndrome is characterized by muscular weakness and obesity. It is usually caused by overproduction of steroids by the body itself through “hyperactive” adrenal or pituitary glands. Overuse of topical steroids can also cause reversible manifestations of Cushing’s syndrome, simply by raising the level of steroids in the body dramatically

Secondary Infection

The steroids normally produced by the body counteract inflammation, which is a primary immune-system response to infection. If such a response is suppressed, by adding extra steroids to the body, it should be obvious that infections may thrive since the immune system will be unable to do its job properly. Most steroids come with the warning to not use them if an infection exists

Hyperglycemia and Glucosuria

Overuse of steroids can lead to hyperglycemia (high blood sugar) and glucosuria (high sugar in the urine). Since the hormones and other chemicals secreted by the adrenal glands have wide-ranging effects throughout the body that suppressing their function can lead to suppression of the creation of insulin


This possible effect is very rare when using topical steroids, but is much more common when oral, or systemic steroids (such as Prednisone) are used

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