When it comes to psoriasis management guidelines, use of systemic corticosteroids are discouraged, but a new study from Wake Forest Baptist Medical Center indicates they are widely prescribed by dermatologists.
Researchers at The Center for Dermatology Research at Wake Forest Baptist assessed how often these drugs - prednisone, dexamethasone and methylprednisolone - were prescribed and trends in their use over time.
"Expert guidelines discourage their use for psoriasis due to concerns about causing flares of generalized pustular psoriasis, but there are no randomized controlled trials of systemic corticosteroids in psoriasis to look at these issues," said Scott A. Davis, M.S., a co-author of the study and assistant director of the Center for Dermatology Research at Wake Forest Baptist Medical Center.
Davis and colleagues used National Ambulatory Medical Care Survey data to determine the systemic medications prescribed for psoriasis from 1989 to 2010. They found that systemic corticosteroids were prescribed at 650,000 of 21 million psoriasis visits. Of these prescriptions, 93 percent were from dermatologists. Corticosteroids were the second most commonly prescribed systemic medication for psoriasis, according to the study which appears online this month ahead of print in the journal of Cutaneous Medicine and Surgery.
Despite the warnings and concerns, the drugs are widely used, the study showed. "Psoriasis has an enormous impact on patients' lives, and there have been major recent advances in treatment," Davis said. "While the new treatments are highly effective and appear very safe, they are costly; their effects are well studied. In contrast, while corticosteroids have been available for decades, their use in psoriasis has not been extensively studied."
Co-authors include: Amir Al-Dabagh, B.S., B.A., Rana Al-Dabagh, B.S., Arash Taheri, M.D., and Steven R. Feldman, M.D., Ph.D., all of Wake Forest Baptist; Hsien-Chang Lin, Ph.D., of School of Public Health, Indiana University; and Rajesh Balkrishnan, Ph.D., of College of Pharmacy, University of Michigan, Ann Arbor.
The Center for Dermatology Research is supported by an unrestricted educational grant from Galderma Laboratories, L.P., for which Feldman is a paid consultant and speaker. There are no funding resources for this work.