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I have been advised that twice weekly application of steroid can be either consecutive or non-consecutive days. What is the mechanism of action that enables topical steroids to be used in a pulse fashion?

My preferred regimen for maintenance treatment is twice daily emollients first and foremost. They keep the acidity and water level of the skin in the normal range. Topical steroids are then used twice a week eg Monday and Thursday to maintain remission. They work by gently reminding the lymphocytes in the skin to remain quiescent and stop being interested in damaging the basal layer (the layer where the epidermis meets the dermis). Lymphocytes are the white blood cells in the skin that trigger LS to develop and they also contribute to causing the flares.

Thanks. I understand the basics of steroid therapy. It is the 'pulse' therapy I don't understand. Could you please explain this?

Thank you for your question. Pulse therapy allows to minimise use of steroids while maintaining efficacy of steroid therapy.

I hope this is helpful.
Best wishes,
Dr Anton Alexandroff
Consultant Dermatologist, Honorary Senior Lecturer & BSF spokesperson - FRCP, CCT (Derm), PhD, FRSM, FAAD
www.alexandroff.org.uk