Anti-inflammatory and anti-proliferative properties of topical corticosteroids help to reduce erythema, scaling and pruritus in psoriasis. Faster onset of action, wide availability, easy to use, non-staining and odorless leads to high acceptability of corticosteroids among patients, affirming their status as first line agents of topical treatment of psoriasis in all ages.
An array of potencies and vehicles are available to choose from including cream, ointment, gel, spray, lotion, solution, nail lacquer, tape and foam. Usually cosmetically acceptable creams are recommended during the day, greasy ointments during the night and foams, lotions and shampoos are selected for scalp psoriasis.
Low to mid-potency (Class 5-7) agents are preferred for face, neck and intertriginous areas, while scalp and extremities are generally treated with mid-potency (class 2-4) topical corticosteroids. Class I corticosteroids or steroids under occlusion rapidly flatten psoriasis lesions but are associated with atrophy and a host of the other side effects.
Topical corticosteroids are widely used for the treatment of chronic plaque psoriasis in face, ears flexures and genital, as monotherapy or in combination.
Side effects of long use of corticosteroids like skin atrophy and striae are especially common in face and flexures. Combination with Calcipotriol or tazorotene can to some extent overcome these side-effects, at the same time corticosteroids can reduce their irritation potential.
Intermittent exposure by pulse therapy, weekend therapy or rotational therapies can further limit these side-effects. Corticosteroids need slow tapering off to prevent any rebound of psoriasis.