Psoriasis, one of the most common dermatoses, occurs in 1 to 3 percent of the population. Although it is rarely life-threatening, psoriasis can cause significant morbidity, social embarrassment, financial cost and disruption in patients’ lives. While patients with extensive and severe disease may require potent oral therapy, less severe psoriasis is typically treated with topical medications.
Topical treatments—medications applied to the skin—are usually the first line of defense in treating psoriasis. Topicals slow down or normalize excessive cell reproduction and reduce psoriasis inflammation. There are several effective topical treatments for psoriasis. While many can be purchased over the counter (OTC), others are available by prescription only.
Common Topical Treatments for Psoriasis
Moisturizers and lotions that you buy without a prescription can keep your skin moist and help control flare-ups. In general, thick, greasy lotions that trap moisture in your skin work best.
Salicylic acid removes scales that appear on patches of psoriasis. It comes in lotions, gels, soaps, and shampoos. It’s especially helpful when used with other skin treatments. Removing flakes of dead skin allows other medications to work more effectively.
Coal tar can help slow the growth of skin cells and make your skin look better. It too comes in many different forms. The weaker products are available over the counter. The shampoo helps treat scalp psoriasis. Coal tar doesn’t smell good, and it can irritate your skin and stain your clothes. Follow the directions carefully. Some studies show that the chemicals in coal tar are cancerous, but this is only true at very high doses. It’s safe to use these products if you follow your doctor’s instructions.
Steroids (corticosteroids) reduce inflammation and slow the growth of skin cells so they don’t build up. They come in different strengths. Weaker formulas may work for sensitive areas like the face, neck, or skin-fold areas like the groin or armpit. You may need stronger ones for tough-to-treat places like your elbows and knees. Your doctor may suggest you wrap the area with tape or plastic after you treat it. This is a method called occlusion. It can help some treatments work better, but it may also make side effects stronger.
The side effects include:
- Thinning of skin
- Changes in skin color
- More visible blood vessels
Make sure you follow your doctor’s directions. Over-using the medicine can lead to more serious health problems. Sometimes, steroids work better when used along with other medications.
Vitamin D creams, lotions, foams, and solutions like calcipotriene (Calcitrene, Dovonex, Sorilux) slow the growth of your skin cells. For long-term use, these products may be safer for you than steroids, but they can irritate your skin. Be careful not to get it on your healthy skin. Some of these medications can make you sick if you swallow them, so keep them away from children and pets. And make sure your doctor knows what other medicines you’re taking. Some can stop vitamin D products from working.
Retinoids, like tazarotene (Tazorac),can help speed up the growth and shedding of skin cells. These gels or creams have vitamin A and come in different strengths. Typically you apply a small dab to each lesion once a day before bed.
Anthralin slows the growth of skin cells and lowers inflammation. It doesn’t have any serious side effects, but it can irritate the skin and stain clothing, sheets, and skin. It’s often used with other medications.
Pimecrolimus (Elidel) and tacrolimus (Protopic) can help stop swelling (inflammation). Your doctor may call these drugs “calcineurin inhibitors.” They’re sometimes used to treat psoriasis when other medications don’t work.
Talk to your doctor before taking these medications, and read the FDA information on these treatments.