If you have plaque psoriasis, the most common form of psoriasis, you know the thick, raised, patches of skin called plaques can be itchy and painful.
With mild to moderate cases of plaque psoriasis, your doctor may recommend using an over-the-counter (OTC) treatment such as a lotion, foam, cream, gel, or shampoo. You put these products directly on your skin or scalp to ease inflammation, pain, and itching.
Although there’s no cure for plaque psoriasis, there are a variety of OTC and prescription treatments that can help keep your symptoms in check.
OTC Topical Treatments to Relieve Plaque Psoriasis Symptoms
When choosing a topical OTC treatment for plaque psoriasis, look for products that contain the following ingredients shown to soften skin, reduce flaking, and soothe itchiness:
Corticosteroids. If you have mild to moderate plaque psoriasis, a topical corticosteroid will very likely be part of your treatment plan: It’s the most-often prescribed medication for both adults and children. It may even be the only medication you need.
Corticosteroids are generally safe, but there are some things you need to remember as you use them:
- Different corticosteroids work best on certain areas of the body. Using one on an area it isn’t designed for can cause worse side effects.
- Steroids range in strength from very weak (least potent) to very strong (most potent), and the risk of side effects goes up with the strength. Use the weakest potency you need for your symptoms.
- Don’t use a corticosteroid for longer than 3 weeks without your doctor’s OK.
- Use the smallest amount you need to cover affected areas.
- Don’t stop using a corticosteroid suddenly. This could cause you to have a flare.
Typical side effects of corticosteroids include:
- Thinning of the skin
- Stretch marks
- Spider veins
- Pimples or rashes
Coal tar. This ingredient has been used for many years to relieve the symptoms of plaque psoriasis. It’s inexpensive, generally safe, and very effective even when used for a long period of time. It treats scaling and itch and can be used on areas of the body such as the scalp, palms, and soles. You can find it in shampoos, ointments, and creams.
Coal tar has a strong odor that some people dislike. It can also stain your skin, hair, or clothes.
While coal tar is safe, in some cases it may:
- Irritate the skin or cause a rash
- Make hair dry and brittle when used on the scalp
- Make psoriasis worse
You shouldn’t use coal tar if you’re pregnant or nursing. Not enough is known about how it affects unborn babies or nursing infants. You should also stay away from coal tar if you’re sensitive to the sun or take medication that makes you sensitive to UV light.
Salicylic acid. This treatment is part of a family of topicals known as keratolytic treatments. They break down keratin, a substance that binds together cells in the top layer of skin. This helps to remove psoriasis scales by letting dead skin cells slough off. It also helps active skin cells hold more moisture in, which makes skin softer.
Lactic acid. A type of alpha-hydroxy acid (AHA), lactic acid is also a keratolytic. It’s a gentler alternative to salicylic acid, although some creams and lotions combine the two.
Urea. Another keratolytic, this natural skin moisturizer soothes, softens, and protects the skin. Urea is sold as a topical cream or ointment in low doses, labeled urea 2 or urea 10, or higher doses, such as urea 40.
The most common side effects of keratolytic treatments are skin redness and irritation, especially at higher concentrations. To keep from irritating healthy skin, be sure to apply topical medications only to psoriasis plaques. Use exactly the amount listed in the directions: Too much can make your psoriasis worse. For best results, take a warm -- not hot -- bath about 15 minutes before you apply them.
These topicals can make you more sensitive to sunlight. To avoid sunburn, stay out of the sun as much as possible and wear protective clothing and sunscreen when you go outside in the daytime.
Nicotinamide (niacinamide). This is a form of vitamin B3, or niacin. It can help to calm the redness and irritation associated with plaque psoriasis. Research has shown that it can help soothe psoriasis symptoms, especially itching. One small study found that a topical 4% nicotinamide cream, used twice daily for 12 weeks, was effective in treating symptoms of plaque psoriasis.
Side effects may include mild skin redness, itching, burning, and light sensitivity.
Ceramides. Ceramides are a type of fatty acid found in skin cells. By restoring the skin barrier, retaining moisture, and hydrating the skin, they’re effective in calming the symptoms of plaque psoriasis. You can find them in many OTC skin care products, such as lotions and facial moisturizers. Side effects are rare but may include stinging, burning, redness, and itching.
In a recent study, ceramides used for a period of 8 weeks eased the severity of plaque psoriasis symptoms. When the test group continued to use ceramides over the course of a year, they tended to relapse less than the control group that did not apply the ceramides.
The Power of Moisturizers
Dry skin can cause symptoms of plaque psoriasis to get worse. Moisturizers will help seal water into your skin so it can heal.
Choose a moisturizer that comes as an ointment, oil, or heavy creams. These tend to work better than lotions in treating plaque psoriasis. Use it at least once a day and even more often if your skin is very dry.
Look for a moisturizer that contains one of more of these ingredients:
- Hyaluronic acid
- Jojoba oil
- Mineral oil
- Shea butter
Using Topical Psoriasis Treatments Safely
When using a new topical product for the first time, it’s important to first see if you’re allergic to it. Start by applying the product to a small patch of skin. If you have a reaction such as increased dryness, flakiness, or an itchy red rash, you may have an allergy or sensitivity to some of the ingredients. Stop using the product right away and check with your doctor to see what other product may work better for you.
What to Stay Away From
OTC treatments for plaque psoriasis aren’t created equal. Some can make your symptoms worse. Steer clear of products that contain dyes, fragrances, and alcohol that can further irritate your skin.
Although a variety of OTC treatments are available to treat plaque psoriasis, most are recommended for mild to moderate cases of the disease. If your plaque psoriasis is severe, your doctor may suggest that you combine an OTC topical treatment with a prescription medication to suppress your immune system.
Finding the right treatment for your plaque psoriasis often takes time. An OTC treatment that works well for one person might not work for you. Also, some OTC products can stop working. If you’re using an OTC product but not seeing results, check with your doctor. They can work with you to make a different treatment plan.
Photo Credit: iStock / Getty Images
National Psoriasis Foundation: “Over the Counter Topicals,” “Steroids.”
HealthLink BC: “Keratolytic Emollients – Topical.”
DermNet: “Salicylic acid.”
American Academy of Dermatology: “What Psoriasis Treatments are Available Without a Prescription?” “Dermatologists’ Top Tips for Relieving Dry Skin,” “Psoriasis Treatment: Coal Tar,” “Psoriasis Treatment: Corticosteroids You Apply to the Face.”
Dermatology and Therapy: “Urea in Dermatology: A Review of its Emollient, Moisturizing, Keratolytic, Skin Barrier Enhancing and Antimicrobial Properties.”
International Journal of Cosmetic Science: “Comparative effectiveness of alpha-hydroxy acids on skin properties.”
Dermatologic Therapy: “Evaluation of safety and efficacy of topical 4% nicotinamide in treatment of psoriasis; among a representative sample of Egyptians (an analytical observational study).”
Skin Pharmacology and Physiology: “Niacinamide - mechanisms of action and its topical use in dermatology.”
Journal of Clinical and Aesthetic Dermatology: “Ceramide- and Keratolytic-containing Body Cleanser and Cream Application in Patients with Psoriasis: Outcomes from a Consumer Usage Study.”
Dermatologic Therapy: “Topical application of a linoleic acid-ceramide containing moisturizer exhibit therapeutic and preventive benefits for psoriasis vulgaris: a randomized controlled trial.”
Advanced Biomedical Research: “Topical nicotinamide in combination with calcipotriol for the treatment of mild to moderate psoriasis: A double-blind, randomized, comparative study.”
Dermatology and Therapy: “Comparing the Potential for Irritation of a Ceramide-Based Moisturizer with a Urea-Based Moisturizer for Pediatric Atopic Dermatitis.”