Psoriasis Patients May Fall Victim to Prescribing Errors

According to most medical experts and current guidelines, corticosteroids are not the medication of choice for psoriasis patients. Yet, a recent study found that hundreds of thousands of dermatology patients have been given these potent medications, a possible example of rampant prescribing errors among the dermatology community.

The study was published in the February 2014 issue of the Journal of Cutaneous Medicine and Surgery by researchers from Wake Forest Baptist Medical Center.

Researchers urge caution, call for more studies

The researchers based their conclusions on an analysis of information from the National Ambulatory Medical Care Survey (NAMCS) that had been reported between 1989 and 2010. The researchers also analyzed information from 2003 to 2007 that had been reported to the MarketScan Medicaid database. The results revealed that out of over 21 million office visits, psoriasis patients were prescribed corticosteroids about 650,000 times. Out of the nine systemic medications that were prescribed most often for psoriasis, three of them were corticosteroids: Enbrel (etanercept), Trexall (methotrexate), and Deltasone (prednisone).

Out of the total number of prescriptions for psoriasis, 93 percent were written by dermatologists. Since skin conditions are a dermatologist’s medical specialty, these doctors should be highly familiar with recommended guidelines for the treatment of psoriasis.
The lead researcher, Scott Davis, called for further studies into the safety and effectiveness of corticosteroids for psoriasis patients. Davis further warned dermatologists to exercise caution when prescribing corticosteroids, stating that sufficient data for an informed decision was lacking. To date, researchers have not yet conducted any scientifically sound studies of systemic corticosteroid medications for psoriasis patients.

Dangerous complications are possible

Psoriasis is a chronic skin condition with symptoms that can range from mild to severe and may occur in a cyclical fashion. The most common type of psoriasis, plaque psoriasis, is characterized by the appearance of raised, red skin lesions coated with silvery scales. These areas often itch or become painful, and they can cause cracking and bleeding of the skin. Other types of psoriasis can result in crumbling nails, outbreaks of sores, pus-filled blisters on the hands and feet, inflammatory eye problems, and swollen, painful joints. Additionally, psoriasis patients may suffer from adverse emotional issues as a result of their condition. Known psychiatric complications include social isolation, depression, stress, and anxiety.

However, despite the severity of these symptoms and complications, psoriasis patients who are prescribed systemic corticosteroids risk complications that may prove even more disabling. Some of the side effects associated with the use of oral, or systemic, corticosteroids include sudden mood swings, osteoporosis, worsening of diabetes, high blood pressure, glaucoma, and cataracts. Blurred vision, suppressed immunity, and insomnia are other possible side effects.

It should be noted that the errors in overprescribing corticosteroids to psoriasis patients is not a result of a lack of alternative treatments. There are a wide range of treatment methods a dermatologist may prescribe, ranging from controlled sunlight exposure to topical medications such as retinoids. Lifestyle changes, over-the-counter salicylic acid, and even light therapy with an excimer laser can help without presenting the risk of the dangerous complications that corticosteroids can have.