Mild to moderate psoriasis means that the red or purple, scaly patches ("plaques") cover less than 10% of your body. But just because your psoriasis is mild doesn't mean it's easy to live with. If the patches are in visible places like your hands or legs, you may be embarrassed to go out without wearing long sleeves and pants. Also, small areas of psoriasis can turn into big problems if they're itchy or painful.
How Your Doctor Chooses Your Psoriasis Treatment
Each person with psoriasis is different. That’s why your doctor will use a few factors to decide which treatment to try:
- The type of psoriasis you have
- How much of your skin is covered
- How big of an impact psoriasis has on your life
- Your health
Your doctor may use the Koo-Menter Psoriasis Instrument to help decide on a treatment. This one-page tool asks questions to find out how much psoriasis affects your life. The doctor can use your answers to determine whether you need a skin cream, light therapy, or a drug that works throughout your body.
Usually doctors start with the mildest treatments for people with mild-to-moderate psoriasis. Often the first treatment you’ll try is a skin cream or ointment. If a mild treatment doesn’t work, you’ll move up to stronger treatments until your doctor finds one that helps you.
In general, you should not apply topical medications to open and infected areas, so speak with your doctor if your skin plaques become actively inflamed.
What it is: Corticosteroids, or steroids, are the most commonly used topical treatment for psoriasis.
How it works: Steroid drugs curb the growth rate of skin cells and reduce inflammation.
Types of corticosteroids: There are a variety of steroid creams, gels, ointments, lotions, and shampoos. They range from weak to strong. The stronger the steroid, the more effective it is. However, stronger steroids also cause more side effects.
- Lower-strength steroids are best for treating sensitive areas for limited periods of time, like the face, groin, skin fold areas, and breasts.
- Higher-strength steroids are best for areas of the skin that don't clear up with milder steroids or areas with thicker plaques.
Side effects include thin skin, changes in skin color, acne, stretch marks, redness, more visible blood vessels, or increased risk for infection. Although uncommon, topical steroids can be absorbed into the circulation and cause side effects such as cataracts, glaucoma, and Cushing’s syndrome. These uncommon side effects are more likely to occur if you use very high-strength topical steroids over a large area for an extended period of time.
Vitamin D Analogues
What it is: A form of synthetic vitamin D that you rub on your skin.
How it works: Vitamin D creams slow skin cell growth.
Vitamin D creams include:
Side effects include skin irritation, burning, itching, dry skin, peeling skin, or rash. In rare cases, too much vitamin D can be absorbed into the body, which can lead to increased levels of calcium.
What it is: A lab-made form of vitamin A.
How it works: It slows skin cell growth and reduces inflammation.
Types of topical retinoids:
- Tazarotene (Tazorac) cream, gel, or foam
Side effects include skin irritation, redness, and sensitivity to sunlight (you need to wear sunscreen while using this medicine). Let your doctor know if you are pregnant or might become pregnant because this medicine may harm an unborn baby.
What it is: A lab-made form of a substance that comes from the South American araroba tree.
How it works: It slows the growth of skin cells.
Types of anthralin:
Side effects include skin irritation. It can also leave brown stains on clothes, hair, bed sheets, and skin.
What it is: The same type of medicine that is used to treat acne.
How it works: Salicylic acid lotions, gels, creams, ointments, pads, plasters, soaps, and shampoos lift scales and help to remove them. Sometimes salicylic acid is used with other psoriasis treatments, such as corticosteroids or coal tar.
Side effects include skin irritation and hair loss.
What it is: A cream or ointment that's applied daily to treat psoriasis
How it works: This treatment slows down skin cell growth.
Side effects vary depending on which topical you've been prescribed but generally include skin irritation, itching, or redness. For roflumilast (Zoryve), side effects can include headache, diarrhea, nausea, insomnia, upper respiratory tract infection, and urinary tract infection.
What it is: Coal tar is one of the oldest treatments for psoriasis.
How it works: Coal tar shampoos, creams, and lotions, gels, ointments, and solutions slow the growth of skin cells. They also reduce scaling, itching, and swelling. The Goeckerman treatment, once widely used, combines coal tar with light therapy. It has fallen out of favor due to its inconvenience.
Side effects include skin irritation and sensitivity to sunlight. Coal tar can also cause strong odor and staining of clothing, bed linens, and hair.
Other Over-the-Counter Treatments
A few other over-the-counter remedies can help treat psoriasis, including:
- Moisturizers containing aloe vera, jojoba, zinc pyrithione, or capsaicin soften skin and relieve itching.
- Bath solutions containing oil, oatmeal, or Dead Sea salts can help remove scales.
- Scale lifters containing salicylic acid, lactic acid, or urea also remove scales.
- Anti-itch creams containing calamine, hydrocortisone, camphor, or menthol can help relieve itching.
Always discuss medications with your doctor, including over-the-counter remedies, to see if they are right for you. Your doctor may also recommend light therapy or an injected drug called a biologic that works throughout your body if your psoriasis is bothering you or having a big impact on your life.