Oral or injected corticosteroids can clear plaque psoriasis quickly, which is why patients sometimes receive them from other prescribers. The problem comes on withdrawal: a rebound flare that can turn pustular or erythrodermic.
This is one of the best-recognised triggers of generalised pustular psoriasis. When a patient with psoriasis has been given systemic steroids elsewhere, taper them slowly under supervision rather than stopping abruptly, and plan the definitive treatment before the taper ends.
- Ask every psoriasis patient about recent oral or injected steroids, including from non-dermatologists.
- Taper rather than stop abruptly when a patient is already on systemic steroids.
- Start a steroid-sparing systemic or biologic agent before the taper finishes.
- Warn patients that a pustular rash with fever after stopping steroids needs urgent review.
Why it matters
A steroid course given for quick relief is a common route into a life-threatening pustular flare.
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