Topical Treatments for Psoriasis

The dry patches of skin you get with psoriasis can be itchy and uncomfortable, but the right treatment plan can help.

Your doctor will likely suggest creams, lotions, foams, sprays, solutions, and ointments. These are called "topicals," meaning you put them directly on your skin or scalp.

A number of products are available. You can get some over the counter (OTC) at the drugstore, but for others you'll need a prescription. It may take time to find what works best for you.

Choosing a Topical

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 better.

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 OTC. 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 puffiness (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.

You'll probably apply your treatment twice a day. 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
  • Bruising
  • More visible blood vessels

Continued

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.

Your doctor will probably suggest you use small amounts twice a day. 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.

Your doctor may suggest you use vitamin D together with a steroid. One medication is a combination of both. It's called Taclonex (calcipotriene and betamethasone dipropionate).

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.

Doctors usually suggest women who are pregnant or who might become pregnant not use these products.

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 black box warning on the label. There may be a link between these drugs and lymphoma (cancer of the lymphatic system) and skin cancer.

When to Change Things Up

These treatments work well for many people, but they aren’t a sure bet. Don't be surprised if something that was working stops -- or if something that’s never helped before starts to do some good. Let your doctor know what makes a difference and what doesn’t. Together, you can choose the right products.

Many topical treatments can irritate your skin, so over time, your doctor may suggest that you cycle through different types of creams. You may also use them along with other types of treatments, like phototherapy or medications you take by mouth or inject.

Before you start using topical treatments, make sure you understand the directions and the side effects they can cause. Stick with your treatment plan, too. If you don't use your medication regularly, your psoriasis could get worse.

WebMD Medical Reference Reviewed by Stephanie S. Gardner, MD on November 15, 2015

Sources

SOURCES: 

Bruce E. Strober, MD, PhD, associate director of Dermatopharmacology, Department of Dermatology, New York University School of Medicine; Co-Director of the Psoriasis and Psoriatic Arthritis Center; consultant for Amgen, Biogen, Genentech, Fujisawa, and 3-M.

Jeffrey M. Weinberg, MD, director of the Clinical Research Center, St. Luke's-Roosevelt Hospital Center, New York City; Assistant Clinical Professor of Dermatology, Columbia University College of Physicians and Surgeons; consultant for Amgen and Genentech.

National Institute of Arthritis and Musculoskeletal and Skin Diseases web site.

American Academy of Dermatology web site.

American Academy of Dermatology, PsoriasisNet web site.

National Psoriasis Foundation web site.

Abel, E. "Dermatology III: Psoriaisis," ACP Medicine, April, 2005.

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