Oral or injected corticosteroids clear psoriasis quickly, but withdrawal can provoke a rebound flare, sometimes generalised pustular psoriasis or erythroderma. When a patient with psoriasis needs a systemic steroid for another condition, warn them, taper rather than stop abruptly, and review the skin soon after. For a psoriasis flare itself, use topical therapy, phototherapy or a conventional or biologic systemic agent instead.
- Do not prescribe a short oral steroid course to settle a psoriasis flare.
- If a steroid is needed for another reason, warn the patient about a rebound flare.
- Taper rather than stop systemic steroids in a patient with psoriasis.
- Review the skin promptly after the course ends.
Why it matters
Steroid withdrawal is a well-known trigger for the pustular flares described in today's lead study.
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