psoriasis and corticosteroids?

[peter90036]

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thinking with all the steroids being given i dont remember anyone remarking pmhx of psoriasis. And frequently in the MKSAP this seems to come up - steroids and psoriasis exacerbation...

When a pt needs systemic steroids are we supposed to change management because of hx of psoriasis ?

 

[jdh71]

Hm. I'm not sure I understand the question.

 

[Instatewaiter]

thinking with all the steroids being given i dont remember anyone remarking pmhx of psoriasis. And frequently in the MKSAP this seems to come up - steroids and psoriasis exacerbation...

When a pt needs systemic steroids are we supposed to change management because of hx of psoriasis ?

Whhhaat?

I think I am reading your question/statement as:
Given the ubiquitous use of steroids, you don't remember anyone saying they have psoriasis...But reading further are you saying steroids worsen psoriasis...

so I repeat... what?

 

[MedicineDoc]

I totally get what you are saying Peter. Steroids. Psoriasis. Hey man. Psoriasis and steroids the MKSAP is down you dig. But are you psoriasi? are you steroid? What do you psoriasis? What do you steroid? Psoriasis. Steroids. Hmmmm. Somethin to think about man.

 

[DIce3]

thinking with all the steroids being given i dont remember anyone remarking pmhx of psoriasis. And frequently in the MKSAP this seems to come up - steroids and psoriasis exacerbation...

When a pt needs systemic steroids are we supposed to change management because of hx of psoriasis ?

My interpretation of the OP: With the frequent use of systemic corticosteroids being used in medicine and the frequent questions about the use of corticosteroids coming up on board exams, does the dosage schedule of coricosteroids need to be modified in a patient with a history of psoriasis?

Answer.. No

 

[Mjs12DO]

I think this is what OP is talking about:
von Zumbusch vatiety where withdrawal of systemic steroids causes severe generalized pustular variant, palmar-plantar pustular.
von Zumbusch vatiety can have generalized erythema, desquamation, and pustular formation. Patient can become systemically ill with high fever, hypotension, weight loss, hypocalcemia, and even death. As a rule systemic steroids should NEVER be used to treat chronic plaque psoriasis and also be very careful when using steroids for other txs in a patient with psoriasis.

 

[peter90036]

u last 2 guys must have special skills.
but yes, Mj got it... however, i have no idea what von Z is and dont remember plaque psoriasis specifically although i could have forgotten that detail.

thank you tho.

 

[Mjs12DO]

Von Zumbusch is obviously a rare phenomenon, and is at the extreme of pustular psoriasis.
The point to remember is garden variety plaque psoriasis can turn into pustular psoriasis when treated with systemic corticosteroids and to use caution.

 

[peter90036]

but when a pt with stable psoriasis has a condition requiring systemic steroids(ex COPD), is a psoriasis exacerbation a rare event?