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Introduction: Orally administered glucocorticoids (OAG) are not recommended for the management of plaque psoriasis (PsO) due to the classically feared outcomes of generalized pustular psoriasis (GPP) and erythrodermic psoriasis (EP). Given their widespread anecdotal use, we hypothesize that the use of OAG is not infrequent among US dermatologists and is rarely complicated by GPP or EP.

Methods: Anonymous electronic survey of 50 US dermatologists. Primary outcomes of interest were the prevalence of OAG in the management of PsO and the prevalence of GPP and EP in the context of OAG tapering.

Results: Overall, 9 out of 50 (18%) respondents occasionally prescribe OAG to patients with PsO. Among those who currently prescribe OAG, 22% (2/9) have had patients who developed GPP/EP. Among the 16% (8/50) of total respondents who at some point encountered GPP/EP from OAG, 75% (6/8) encountered GPP/EP in the context of OAG tapering and 50% (4/8) encountered GPP/EP without OAG tapering. Effectively all (98%) respondents were aware of the risk in patients with PsO of developing GPP and EP in the context of OAG tapering.

Discussion: The use of OAG for PsO is not uncommon among dermatologists, despite universal awareness of the risk of GPP and EP. Surprisingly, a number of providers have encountered GPP/EP in the context of OAG usage for PsO. Our findings provide novel support for the standard of care by suggesting a relationship between the use of OAG and the development of GPP and EP.