Psoriasis

Psoriasis topical treatments: steroid creams

Topical steroids are prescribed by a doctor to help control psoriasis by reducing inflammation (swelling) and to slow down skin cell production, which can help with itchiness. They are often prescribed with vitamin D analogues, either as a combined cream or as an additional cream. Almost everyone we talked to had used topical steroids, which are rubbed into the skin. The only exception was Carys whose psoriasis was so flared-up when she was first diagnosed that her dermatologist recommended phototherapy instead.
The topical steroids young people used for psoriasis varied in:
  • main steroid type/ingredients – for example, hydrocortisone or clobetasone (Eumovate, Trimovate, Dermovate) or betamethasone butyrate (Betnovate) 
  • form (cream, ointment) 
  • potency (the strength – this depends on how much steroid it contains) 
  • for different body parts
There were mixed experiences of topical steroids. Some people, like Jack and Russell, found they worked well so didn’t need any other treatments. Jack says his steroid creams help “ease the soreness”. Louis found they provided a ‘barrier’ between his skin and clothes so that they rubbed less. Others didn’t find topical steroids helped or had become less effective after a while. Adam says “the generic thing stopped working for me”. Lots of people felt topical steroids worked for some people but less effectively for others. It could be frustrating trying lots of different steroid creams – Zara and Abbie lost hope at times. Some people worried they had run out of psoriasis treatments to try if steroid creams stopped working for them. A few felt there aren’t enough ‘new’ psoriasis treatments being developed. Steven thinks topicals are less ‘glamorous’ than other medicines: “you don’t tend to hear in the news like, “A wonderful new cream has been made”. Like, there’s no like, they’re not going to report that. “A wonderful new tablet”, they’re like, “Yay, tablets, drugs.””. A few people found it irritated their skin if their topical steroids dried out and became ‘cakey’ during the day. Lucy finds steroid treatments loosen her skin flakes and says she vacuums more often. 

Instructions for using topical steroids from medical professionals depend on things like the severity of psoriasis and where it is on the body. Some people said they only use a steroid cream on occasions when they have flare-ups. Others use topical steroids as part of their routine for managing psoriasis – Ella explains, “I put my creams on every single night”. Damini’s doctor told her to only use steroid cream for a certain amount of time, but she’s unsure what to do after this. Adam says if he has a bad day and thinks his psoriasis is more visible, it “will then trigger me to go home and start treating my skin”.
Most saw topical steroids as the first treatment choice for psoriasis. If these didn’t help, they knew other treatments might be offered – such as tacrolimus creams, dithranol topicals, phototherapy and systemic treatment. Lucy explains “it can be frustrating if your psoriasis is quite bad and you’re still getting creams and stuff and you maybe want something a bit stronger. But, I understand that they have to be thorough and professional and go through all the stages”.

As well as general difficulties with using topical treatments (time-consuming, messy, sticky, smelly, stains), there were other concerns about topical steroids. Very potent steroids have to be used carefully as they can sometimes cause problems like ‘rebound’ flares when treatment is stopped. Some young people we talked to worried about skin thinning and damage to the kidneys, but had not experienced these themselves. Lola stopped using steroid creams for a while out of concern but eventually went back to them. Adam’s doctors wanted him to stop using steroid creams as he had been on them a long time, but he didn’t want his psoriasis to flare-up. Sofia and Damini thought steroid creams had caused white patches on their skin (hyperpigmentation). Steven finds some steroid creams sting when he first uses them. Lucy says the steroid creams can irritate acne on her shoulders.
Doctors often told people to be careful about using steroid creams on their face, where the skin is thinner and more sensitive. Many had been prescribed a weaker steroid cream for this area and other sensitive parts (like the breasts) than for the rest of their body. Others, like Adam, used the same steroid cream but tended to apply less on the face.
Though it is important to be careful when using steroid creams, some found it frustrating if they felt that their doctor wouldn’t give them a strong enough topical steroid or consider other treatments. Simon was given a medicated shampoo when he was first diagnosed with scalp psoriasis and thinks a steroid treatment would have worked better.
Topical steroids helped some people maintain their skin after other psoriasis treatments had worked well. Megan and Abbie find steroid creams are enough to keep on top of their psoriasis since finishing other treatments (biological injections, phototherapy). Simon has nail psoriasis and thinks rubbing a liquid-y steroid treatment on his scalp helps by getting under his fingernails.

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