Medical Health Encyclopedia

Topical steroids generally have been administered twice a day. Studies are reporting, however, that certain agents can be applied effectively only once daily. Most studies have used high-potency steroids, but a 2001 study suggested that medium-potency agents, such as triamcinolone (Aureocort, Tri-Adcortl), may be equally beneficial as a once-daily treatment. In any case, however, corticosteroids used alone are effective in clearing psoriasis in only 4% to 36% of patients.

Combinations with other agents are often needed. For example, an effective, topical regimen uses the following combination for maintenance therapy:

• A high-potency steroid (e.g., halobetasol) on the weekend.
• The vitamin D3 topical agent, calcipotriene, twice daily on weekdays.

In one study, over three-quarters of patients with mild to moderate psoriasis remained in remission for at least six months with this regimen.

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Side Effects. The more powerful a drug, the more effective it is. But it also has a higher risk for severe side effects. They can include the following:

• Burning.
• Irritation.
• Dryness.
• Acne.
• Thinning of the skin that may become shiny, fragile, and easily cut.
• Dilated blood vessels.
• Loss of skin color.

Corticosteroids should not be used during pregnancy or when nursing. The high-potency drugs carry a small risk for adrenal insufficiency, which is usually mild. If this occurs, the body loses its ability to produce natural steroid hormones for a period of time after the drug has been withdrawn, which can cause serious complications. With topical steroids, however, this event is uncommon and usually mild.

Loss of Effectiveness. In most cases, the patients become tolerant to the effects of the drugs, and they become ineffective. Some experts recommend using intermittent therapy (called weekend or pulse therapy), which involves applying a high-potency topical agent for three full days each week. In one study, intermittent treatment maintained improvement for six months in 60% of patients.