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(Medrol) for P?
Hi again Ed.
I say "again"
because a while back I emailed regarding my thoughts about Accutane as a
trigger for my psoriasis [see Accutane
for acne — P Trigger?].
Last week I
went to see my rheumatologist for a checkup.
I have a "moderate" case of PA in my fingers and he
prescribed a drug for it called "Methylprednisolone," which is a
My fingers are
gradually improving. But the
biggest improvement is in my psoriasis.
My lesions have cleared up immensely, leaving me with just patches
of "newbie" pink skin on my arms,
back, and legs. An inadvertent
but most pleasant surprise!
Have you or any
of the other "flakers" out there heard of this drug, let alone
been taking it? If so, is
there a concern over organ damage as is the case with MTX?
While I would prefer steering clear of steroids, there's a lot to
be said for having almost-normal skin again!
All the best,
Response: Good to hear from
you, Tom. Your inquiry about methylprednisolone drove me to my PDR Family Guide to Prescription Drugs, where I learned about it
under the brand name Medrol. First
thing I read was that, among the many conditions for which it is
prescribed, including arthritis, is “severe psoriasis.”
So I suppose your skin improvement might have been anticipated by
“most important facts” about this drug is that it lowers resistance to
infections and can make them harder to treat.
(Don’t take the Small Pox vaccine while you’re on Medrol.)
Derms have known for years that taking corticosteroids internally
can palliate P, but it’s been a “last resort” treatment, probably
because the many side effects are not worth the temporary relief that can
be obtained. (The drug is
certainly not to be taken long-term.)
Derms will still use drugs like Medrol, especially when the severe
P is causing severe problems (as is often the case with Erythrodermic P).
But the rub is that extensive P lesions increase the likelihood of
infections for a number of reasons and any treatment for the lesions that
lessens resistance to infections may be the proverbial “cutting off of
ones nose to spite ones face.”
The Family PDR
also says that when it’s time to stop taking Medrol, it should be
“phased out” rather than suddenly stopped.
This means gradually reducing the dosage.
While this wasn’t explicitly stated, I would take this as a
strong indication that serious P rebounds are likely when the drug is
stopped. This shouldn’t be
surprising, either. I’ve not
yet come across a systemic (taken internally) medicine for P that doesn’t
cause serious rebound when it’s stopped!
If you are
seeing a derm in addition to your rheumy, you should let him know you are
taking methylprednisolone and responding well.
He can counsel you on how long to take it (from his dermatologic
point of view), how to taper off, and what to do after Medrol to avoid
Tom, last time you wrote was September, 2001.
Posting this doesn’t mean you have to wait 19 months to write
again! <wink> -Ed