Only definitive indication of systemic steroids in psoriasis is

D i.e. Impetigo herpetiformis - Systemic steroids should be avoided in routine care of psoriasis Q because the disease usually breaks through, requiring progressively higher doses to control symptoms and withdrawl of drug is usually associated with frequent relapse in form of life threatening erythrodermic psoriasis (with exfoliative dermatitis) and pustular psoriasis (with pus lakes)Q. - However, systemic steroids may have a role in management of Persistent, otherwise uncontrollable (e.g. with metabolic complications), psoriatic erythroderma and in fulminant generalized pustular psoriasis (von Zumbusch type) if other drugs are ineffective or contraindicatedQ. Pustular psoriasis in pregnancy is called impetigo herpatiformis. In pregnancy, safest drug for treatment of pustular psoriasis is prednisoloneQ. Severe psoriatic polyahritis threatening severe irreversible joint damageQ. Pustular psoriasis may develop after strong topical or systemic steroids have been used and then abruptly withdrawnQ. It presents with development of generalized pustules all over the bodyQ. Erythematous skin rash with multiple pus lakes suggests a diagnosis of generalized pustular psoriasis. As retinoids, methotrexate & PUVA cannot be used (or contraindicated) in pregnancy. Coicosteroids form the mainstay of treatment for generalized pustular psoriasis in pregnancyQ. Localized disease is best treated with topical steroid & fulminating generalized disease is best treated with systemic prednisolone (oral).