Systemic Corticosteroids Are Frequently Prescribed for Psoriasis

Background: The use of systemic corticosteroids is discouraged in major psoriasis treatment guidelines. Purpose: Our objective was to assess how often systemic corticosteroids are prescribed for psoriasis and trends in their use over time. Methods: We used National Ambulatory Medical Care Survey (NAMCS) data to determine the systemic medications prescribed for psoriasis from 1989 to 2010. We confirmed the findings by analysis of 2003-2007 MarketScan Medicaid data. Results: Systemic corticosteroids were prescribed at 650,000 (95% CI 380,000-920,000) of 21,000,000 psoriasis visits; 93% of these visits were to dermatologists. Of the top nine systemic medications listed at psoriasis visits, three of them were corticosteroids. Corticosteroids were the second most commonly prescribed systemic medication for psoriasis. No significant change in the use of systemic corticosteroids for psoriasis over time was observed (p = .27). In the MarketScan data, prednisone was prescribed more commonly than either methotrexate or etanercept. Limitations: Corticosteroid doses and the length of treatment were not recorded in the NAMCS data. Conclusions: Systemic corticosteroids are among the most common systemic treatments used for psoriasis despite current guidelines. Data are acutely needed on the risks and benefits so that physicians and patients can make evidence-based decisions about their use.