For most people with mild psoriasis, therapy begins with topical treatments. These are medications in creams, solutions, lotions, foams, sprays, or ointments that are applied to the skin and scalp. There are a number of different approaches possible. It may take some time to find the one that works best for you.
Here are some of the most common topical treatments.
Corticosteroids, or steroids, are the most commonly prescribed drug for psoriasis. They are often used to treat mild to moderate cases. They work by reducing inflammation and slowing the growth and build-up of skin cells.
Topical corticosteroids come in different strengths designed for use on different parts of the body. Stronger potency steroids might be necessary for tough to treat areas of psoriasis on the elbows or knees. Weaker formulas are good for more sensitive skin on the face or groin. Directions for use vary depending on the particular medication. You will probably have to apply it once or twice a day. Your doctor may recommend that you try occlusion, which means applying the steroid cream and then wrapping the area with tape or plastic to increase the effect.
Steroids can cause side effects, such as thinning of the skin, changes in the skin color, bruising, and dilated blood vessels. Occlusion may increase these side effects. If steroids are used on too much of the body, it's possible to develop more serious health problems.
Although steroids may work very well at first, your psoriasis may become resistant to them over time. Topical corticosteroids are now often used in combination with topical vitamin D analogs such as calcipotriene (Dovonex) or topical retinoids such as tazarotene (Tazorac). In some cases, steroids may be injected instead of applied to the surface of the skin.
Vitamin D analogues. Dovonex (calcipotriene) is a form of vitamin D that is sold as a cream, ointment, or solution. It treats psoriasis by slowing down the growth of your skin cells, and it's safer than steroids for long-term use. Because Dovonex can irritate the skin, it should only be used in small amounts. Be careful not to get it on the healthy skin surrounding the psoriatic plaques. Your doctor will probably tell you to apply it twice a day. Dovonex is toxic if ingested, so keep it away from pets and children. You may use Dovonex together with a corticosteroid. Be careful with any medications that you use along with Dovonex. Some topical medicines, like salicylic acid, can stop it from working.
Another new vitamin D analogue has been introduced and contains both a topical steroid and calcipotriene (Taclonex).
Tazorac (tazarotene) and other retinoids are gels or creams derived from vitamin A. Retinoids come in different strengths to treat different types of psoriasis in different locations, including the scalp and nails. Usually, you would apply a small dab to each lesion once a day, before bed. Tazorac is often combined with steroid treatment. Women who are pregnant or who might become pregnant should probably not use topical retinoids.