Psoriasis Flares Following Systemic Glucocorticoid Exposure in Patients With a History of Psoriasis

To our knowledge, this study is the first to assess the rate of any type of psoriasis flare during or immediately following the administration of systemic corticosteroids in patients with a known history of psoriasis.

To determine the rates and types of psoriasis flares during or within 3 months after concluding systemic corticosteroid administration in adult patients with a known history of psoriasis.

This retrospective cohort study assessed adult patients (≥18 years at the time of psoriasis diagnosis) evaluated in the Marshfield Clinic Health System (Marshfield, Wisconsin) with an established diagnosis of psoriasis and exposure to at least 1 systemic corticosteroid from October 31, 2012, to July 1, 2018. Exclusion criteria were patients younger than 18 years, patients with a diagnosis of psoriatic arthritis, and patients receiving only topical, intraarticular, or intrabursal corticosteroids.

The primary outcome was rate of psoriasis flares during or within 3 months of discontinuation of the patient's first course of systemic corticosteroids. Secondary measures included rates of specific types of psoriasis flares, including pustular, erythrodermic, and worsening plaque stage psoriasis.

Of 516 cohort patients, 288 (55.8%) were women, and the mean (SD) age at first psoriasis diagnosis was 49.6 (17.0) years. Among 1970 patients with a diagnosis of psoriasis before receiving systemic corticosteroids, a 1.42% (95% CI, 0.72%-2.44%) psoriasis flare rate of any type was identified when prescribed their first course of systemic corticosteroids. Further stratification identified only 1 severe flare (erythroderma) among all flares reported, with no pustular psoriasis flares identified (0.07%; 95% CI, 0.00%-0.26%).

In this study, the rates of psoriasis flares were low, especially for severe psoriasis flares. Our results suggest that systemic steroids may be much less likely to trigger severe flares in patients with psoriasis than what is traditionally taught in dermatology.