A corticosteroid cream or ointment might be the first treatment you try for plaque psoriasis. Topical steroids are often a doctor's go-to because they're safe and they work, but they're not your only weapon against psoriasis. If a steroid doesn't clear your skin enough, you also have a lot of nonsteroidal treatments to choose from.
Many creams, ointments, and other products that you rub on your skin don't contain corticosteroids. Instead, they're made with ingredients like vitamin A and vitamin D3 that put the brakes on skin cell growth and help clear up scaly patches.
What Are My Nonsteroidal Topical Treatment Options?
Nonsteroidal topicals fall into eight categories. Your doctor will help you find the medicine that works best for you. A little patience and persistence could pay off in clearer skin.
The main ingredient in this topical treatment comes from the bark of the South American araroba tree. Anthralin has been a psoriasis treatment for close to 100 years. How it works is still a mystery, but it does bring down inflammation and slow the growth of skin cells.
Anthralin isn't used as much today because it can irritate and stain the skin. That's why your doctor will start you on a low dose. To prevent irritation, don't use anthralin on your face. Keep the medicine on your skin for only 5 to 10 minutes at a time and then wash it off. Your doctor can slowly increase the dose and treatment time as you get used to anthralin.
Wear gloves when you apply anthralin and wash your hands with soap and water afterward to prevent stains. Apply a layer of petroleum jelly to protect your skin around the treatment area.
Vtama is the newest topical psoriasis treatment. It works on your immune system to reduce inflammation and prevent scales. In studies, up to 40% of people who used this cream had clear or almost clear skin. Some stayed clear for months after they stopped the treatment.
The most common side effects with Vtama are:
- Red bumps around the area where hairs grow (folliculitis)
- Colds and flu
- Skin rash
Medicines like pimecrolimus (Elidel) and tacrolimus (Protopic) block a protein that inflames the skin. Calcineurin inhibitors help bring down swelling and reduce scales. These medicines can be useful in sensitive areas like your face where a corticosteroid might irritate too much. After you start on a calcineurin inhibitor, you may be able to cut down on your steroid use or stop using steroids completely.
Calcineurin inhibitors can cause burning and itching. You can prevent these side effects by drying your skin before you apply them.
These medicines come with a boxed warning that they increase the risk for skin cancer and lymphoma. Although there's no clear evidence that they cause cancer, your doctor might keep you on them for only a short period of time to be safe.
Doctors have prescribed coal tar to treat psoriasis for more than 100 years. This treatment has been around for so long because it relieves itching and scales, and it works on hard-to-treat areas like the palms of the hands, soles of the feet, and scalp.
Coal tar comes in prescription and over-the-counter versions. You can buy it as a cream, lotion, ointment, oil, or shampoo that you use once a day.
The downsides to coal tar are its odor and the stains it can leave on skin, hair, and clothes. You may want to use these products at night before bed and wear clothes that you don't mind getting messy.
Doctors don't know how coal tar might affect a growing baby. It's safer to use a different treatment during pregnancy and while nursing.
Zoryve is another new plaque psoriasis cream. It blocks a substance called PDE4 that inflames the skin. In studies, almost half of people who used this topical had clear or almost clear skin after 8 weeks.
The most common side effects with Zoryve are:
- Colds and other infections
- Trouble sleeping
- Urinary tract infections
Tazorac is a form of vitamin A called a retinoid. When you apply it as a cream or gel once a day, it slows the growth of skin cells to reduce scales and improves the look of thickened nails. It’s also combined with a corticosteroid as a lotion to treat adults with plaque psoriasis.
Tazorac works best for mild-to-moderate plaque psoriasis. It also helps light therapy work better if you use the two treatments together.
This medicine can irritate your skin. To protect your skin while you use Tazorac, try these tips:
- Take Tazorac with a steroid.
- Use it every other day instead of every day.
- Wash off the medicine after 20 minutes.
- Rub a moisturizer onto your skin.
Tazorac can also make your skin more sensitive to the sun. Protect your skin with sunscreen and sun-protective clothing while you use it.
This medicine isn't safe to use during pregnancy. The drug's manufacturer recommends that women get a pregnancy test about 2 weeks before they start Tazorac to make sure they aren't pregnant.
This ingredient is found in over-the-counter and prescription shampoos, creams, and gels. It softens and removes scales to improve the skin's appearance. Salicylic acid works best for mild to moderate psoriasis. For moderate to severe psoriasis, it's often combined with a corticosteroid or other topical treatment.
Don't apply salicylic acid before phototherapy because it can make light therapy less effective. Avoid this medicine if you have kidney or liver disease. Salicylic acid may not be safe to use if you're pregnant.
Vitamin D Analogs
Calcipotriene (Dovonex) and calcitriol (Vectical) are synthetic (human-made) forms of vitamin D3. These medicines slow the growth of new skin cells. You can use these medicines alone or with topical corticosteroids to help them work better.
Dovonex comes in a cream, liquid, ointment, and foam. Vectical is only available as an ointment. Both are applied to the skin twice a day.
These medicines can make the skin burn, itch, or peel. Vectical may be less irritating to sensitive areas of skin than Dovonex.
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American Academy of Dermatology: "Psoriasis Treatment: Coal Tar."
BPAC NZ: "Choosing a Topical Treatment for Patients with Chronic Plaque Psoriasis."
JAMA: "Nonsteroidal Topical Treatment for Plaque Psoriasis is Approved."
Journal of the American Academy of Dermatology: "Joint AAD-NPF Guidelines of Care for the Management and Treatment of Psoriasis with Topical Therapy and Alternative Medicine Modalities for Psoriasis Severity Measures."
Mayo Clinic: "Psoriasis."
National Psoriasis Foundation: "Non-Steroidal."
NYU Langone: "Topical Medication for Psoriasis."
The Annals of Pharmacotherapy: "A Review of Topical Roflumilast for the Treatment of Plaque Psoriasis."
UpToDate: "Treatment of Psoriasis in Adults."