Systemic steroids in the treatment of psoriasis: what is fact, what is fiction?

Mrowietz, Ulrich; Domm, Silja

doi:10.1111/j.1468-3083.2012.04656.x

Cited by 54 publications

(38 citation statements)

References 23 publications

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“…However, systemic steroid use, particularly at high doses, has been reported to cause flares of skin psoriasis. Therefore, systemic steroids should be used with caution, and at the lowest effective dose [Gossec et al 2012;Mrowietz and Domm, 2013].…”

Section: Nsaids and Corticosteroidsmentioning

confidence: 99%

Psoriatic arthritis: latest treatments and their place in therapy

Kang

Kavanaugh

2015

Therapeutic Advances in Chronic Disease

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Psoriatic arthritis (PsA) is a heterogeneous chronic inflammatory disease that may affect peripheral and axial joints, entheses, skin and nails, and other organs. Treatment with nonsteroidal anti-inflammatory drugs, steroid and disease-modifying antirheumatic drugs had been the backbone of traditional management of PsA for many years. However, improvement in our understanding of immunopathogenesis of PsA has led to new immunomodulatory therapies. Introduction of novel agents has raised the bar for treatment and helped drive research into additional therapeutic options.

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Section: Nsaids and Corticosteroidsmentioning

confidence: 99%

Psoriatic arthritis: latest treatments and their place in therapy

Kang

Kavanaugh

2015

Therapeutic Advances in Chronic Disease

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“…During the last, more severe flare, oral corticosteroids were used at the beginning and then were replaced with systemic retinoid again. Systemic corticosteroids generally are not recommended in GPP because of the risk of rebound phenomenon flares after reducing the dose or drug withdrawal; however, a recent literature review by German authors [4] revealed a lack of studies confirming this risk. Clinical experience suggests that the risk of the withdrawal effect may be reduced by combination of corticosteroids with another systemic agent which will be continued after their cessation [4].…”

Section: Discussion Standard Therapymentioning

confidence: 97%

Prace oryginalne Generalised pustular psoriasis – a and review of therapeutic approaches

Osmola‐Mańkowska¹

2014

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Introduction.Generalised pustular psoriasis (GPP) is regarded as a rare clinical subtype of psoriasis. The severity of GPP varies from a benign, chronic course to severe and widespread, life-threatening disease. Due to the uncommon nature of GPP, establishing treatment guidelines for this variant of psoriasis is challenging. Objective. To present the case of a patient with GPP with a short review of therapeutic approaches. Case report. Our patient was treated with standard methods such as acitretin, then cyclosporine and methotrexate as well as with biologic druginfliximab. During the last and the most severe flare, combination therapy with systemic retinoid and PUVA (Re-PUVA) was used. Conclusions. The treatment in GPP should be determined individually according to the severity of the disease, age, gender and comorbidities, as well as according to the physician's experience with particular methods and their side effects. In addition, the availability of therapeutic options should be taken into consideration. streszczenie Wprowadzenie. Łuszczyca krostkowa jest odmianą kliniczną łuszczycy, której przebieg może być bardzo ciężki i zagrażać życiu. Ze względu na rzadkość schorzenia ustalenie pewnych standardów leczenia okazuje się bardzo trudne. Cel pracy. Przedstawienie przypadku ciężkiej, uogólnionej łuszczycy krostkowej wraz z krótkim przeglądem piśmiennictwa dotyczącego możliwości leczenia. Opis przypadku. Pacjent był leczony zarówno dostępnymi metodami standardowymi, obejmującymi acytretynę, cyklosporynę A i metotre ksat, jak i lekiem biologicznym -infliksymabem. Podczas ostatniego, najcięższego zaostrzenia zastosowano acytretynę w połączeniu z fotochemioterapią PUVA -RePUVA. Wnioski. Wybór metody leczniczej powinien zależeć ściśle od ciężkości stanu klinicznego, wieku pacjenta i chorób współistniejących. Doświadczenie lekarza i dostępność danego leku to również bardzo ważne cechy determinujące sposób leczenia.

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“…Based on these evidences we can say that in our patient the etiology of perforation was long standing prednisolone therapy. However, the role of steroid treatment in psoriasis is doubtful [10]. There was no history suggestive of diverticulitis or diverticular bleeding before coming to our hospital.…”

Section: Discussionmentioning

confidence: 99%

Steroid Induced Perforation of Meckel's Diverticulum in an Adult

Senthilnathan¹,

Sivakumar²,

Dey³

et al. 2017

JCR

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Background: Perforation is one of the rare complications of Meckel's diverticulum (MD) which carries high morbidity and mortality. Being a congenital variant, complicated MD is usually seen in pediatric population. Case Report: An adult male diagnosed with psoriasis and on systemic steroids for last three months presented with generalized abdominal pain, and distension. Free fluid and gas in abdomen were detected in erect abdominal X-ray and CT scan. Exploratory laparotomy showed perforated MD. Histopathology report showed presence of ulceration and perforation near ectopic gastric mucosa. The normal diverticular mucosa was ulcerated and perforation was due to persistent low pH inside the diverticulum. Conclusion: High dose systemic steroid therapy may cause spontaneous MD perforation. Detailed history coupled with high degree of clinical and radiological suspicion is required to clinch the pre-operative diagnosis.

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Systemic steroids in the treatment of psoriasis: what is fact, what is fiction?

Abstract: A re-evaluation of the treatment of psoriasis and/or psoriatic arthritis with systemic steroids is necessary.

Cited by 54 publications

References 23 publications

Psoriatic arthritis: latest treatments and their place in therapy

Psoriatic arthritis: latest treatments and their place in therapy

Prace oryginalne Generalised pustular psoriasis – a and review of therapeutic approaches

Steroid Induced Perforation of Meckel's Diverticulum in an Adult

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