DISCUSSION
Our study suggests that OAG for the management of psoriasis is not uncommon among US dermatologists, despite nearly universal awareness of its risks. Usage was higher in younger physicians, parenteral administration was frequent, and bridge therapy to DMARDs/biologics was the favored indication. While a substantial percentage of respondents (16%) have seen at least 1 case of OAG-related GPP/EP, historically, flare rates are extremely low.5,6 When dermatologists do see OAGrelated GPP/EP, we cannot assume with certainty that systemic glucocorticoid therapy was causally related, as OAG may be instituted when managing a patient with aggressive psoriasis that is headed toward a pustular flare. Moreover, in view of the high prevalence of OAG use for psoriasis, it is intriguing that only 16% of dermatologists report having observed one or more cases of OAG-associated GPP and that the majority of these were reported by dermatologists who did not prescribe OAG for psoriasis. The small sample size and questionnaire platform are limitations. Prospective studies would help better characterize OAG’s risk/benefit profile in psoriasis.
DISCLOSURES
S. Feldman has received research, speaking, and/or consulting
support from a variety of companies including Galderma, GSK/
Stiefel, Almirall, Leo Pharma, Boehringer Ingelheim, Mylan,
Celgene, Pfizer, Valeant, Abbvie, Samsung, Janssen, Lilly,
Menlo, Merck, Novartis, Regeneron, Sanofi, Novan, Qurient,
National Biological Corporation, Caremark, Advance Medical,
Sun Pharma, Suncare Research, Informa, UpToDate, and
National Psoriasis Foundation. He is founder and majority
owner of www.DrScore.com and founder and part-owner of
Causa Research, a company dedicated to enhancing patients’
adherence to treatment. The authors have no other relevant
affiliations or financial involvement with any organization or
entity with a financial interest in or financial conflict with the
subject matter or materials discussed in the manuscript apart
from those disclosed.
REFERENCES
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4. Augustin M, Schäfer I, Reich K, Glaeske G, Radtke M. Systemic treatment with corticosteroids in psoriasis--health care provision far beyond the S3- guidelines. J Dtsch Dermatol Ges. 2011;9(10):833-8.
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6. Gregoire ARF, DeRuyter BK, Stratman EJ. Psoriasis flares following systemic glucocorticoid exposure in patients with a history of psoriasis. JAMA Dermatol. 2020 Nov 18:e204219.
2. Boyd AS, Menter A. Erythrodermic psoriasis. Precipitating factors, course, and prognosis in 50 patients. J Am Acad Dermatol. 1989;21:985–991.
3. Al-Dabagh A, Al-Dabagh R, Davis SA, et al. Systemic corticosteroids are frequently prescribed for psoriasis. J Cutan Med Surg. 2014;18(3):195-9.
4. Augustin M, Schäfer I, Reich K, Glaeske G, Radtke M. Systemic treatment with corticosteroids in psoriasis--health care provision far beyond the S3- guidelines. J Dtsch Dermatol Ges. 2011;9(10):833-8.
5. Mrowietz U, Domm S. Systemic steroids in the treatment of psoriasis: what is fact, what is fiction? J Eur Acad Dermatol Venereol. 2013;27(8):1022-1025.
6. Gregoire ARF, DeRuyter BK, Stratman EJ. Psoriasis flares following systemic glucocorticoid exposure in patients with a history of psoriasis. JAMA Dermatol. 2020 Nov 18:e204219.
AUTHOR CORRESPONDENCE
M. Anthony Albornoz MD tonyalbornoz@gmail.com
