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Steroid Rebound Psoriasis — SCE Dermatology MCQ

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EasyInflammatory DermatosesSteroid Rebound PsoriasisSCE Dermatology

A 50-year-old man with psoriasis develops erythroderma after abruptly stopping systemic corticosteroids. Why is systemic steroid withdrawal dangerous in psoriasis?

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Correct answer: CAbrupt steroid withdrawal in psoriasis can trigger severe rebound flare including erythrodermic or pustular psoriasis — steroids should not be used for psoriasis maintenance; if used short-term, taper carefully

Systemic corticosteroids are generally avoided in psoriasis management because: (1) withdrawal triggers severe rebound flare that is often worse than the original disease (erythrodermic or generalised pustular psoriasis); (2) the disease becomes steroid-dependent; (3) long-term steroid side effects are unacceptable for a chronic relapsing condition. When systemic steroids have been prescribed (e.g., by non-dermatologists or for other indications), careful tapering with simultaneous introduction of appropriate steroid-sparing therapy is essential. BAD guidelines specifically warn against systemic corticosteroids for psoriasis except in exceptional circumstances (e.g., pregnant patients with severe disease, as a bridge to safer therapy).

Reference: BAD 2020 Psoriasis Guidelines