Psoriasis is a lifelong condition that comes and goes in flares, and the key to managing it is the right treatment. Your dermatologist will help you find a therapy based on:
- How bad your symptoms are
- Which part of your body psoriasis affects
- Which form of the condition you have
Topicals are a common type of psoriasis medicine that you apply to your skin to soothe irritation and scaling.
If you have mild psoriasis, your doctor may suggest an over the counter treatment such as:
- Creams or ointments with hydrocortisone
- Coal tar products
- Scale softeners with salicylic acid
Treatments for serious symptoms are more targeted. They include prescription topical medicines that come in the form of a cream, ointment, or shampoo. You may use them in combination with other types of treatment. Here’s a closer look at what you can expect with topicals.
How Should You Apply a Topical?
You’ll apply a topical to the psoriasis-affected area once or twice a day. With some products, it’s essential to test a small area of skin (called a patch test) to make sure the medication won’t cause further irritation.
If you’re using a topical steroid, apply only a small amount to the areas of your skin impacted by psoriasis. The standard amount is one fingertip to cover the area of about two adult-sized palms. Unless your doctor says it’s OK, don’t apply a topical steroid near your eye area. This can cause eye problems such as cataracts and glaucoma.
What Are the Side Effects of Topicals?
Side effects of topicals can range from mild to serious. They vary depending on the type of medication you use. Possible negative reactions include:
- Thinning of skin
- Skin color changes
- Bruising without much effort
- Stretch marks
- Enlarged blood vessels
If you apply a topical steroid to a broad area or use it for an extended amount of time, there’s also a chance it will absorb through your skin and affect your internal organs.
- Irritated skin
- A stinging or burning feeling
- Dry, itchy, peeling skin
- Worsened psoriasis
- Sun sensitivity and a higher chance of skin tumors
- Too much calcium in your pee
- Raised bumps around your hair
- Nose and throat pain or swelling follicles
- Trouble falling or staying asleep (insomnia)
- Feeling sick to your stomach (nausea)
- Upper respiratory tract infection
- Urinary tract infection (UTI)
Over the counter topicals
Many over-the-counter psoriasis products contain the ingredient salicylic acid. It works by softening, lifting, and removing psoriasis scales. If you leave it on your skin for too long, though, it can irritate the skin. And if you use it on a large area of skin, your body may soak up too much of it, which can cause further health problems.
Another over-the-counter product, coal tar, also comes with possible side effects such as skin irritation, dryness, and color changes. You could also become more sensitive to sunlight, so wear sunscreen and protective clothing and stay out of the sun as much as possible while using this product.
Combining Topicals or a Topical With Another Type of Treatment
Serious psoriasis symptoms may require a combination of treatments. Your dermatologist could suggest applying a topical while also using phototherapy (light therapy) or taking an immunosuppressant, biologic, or small molecule inhibitor.
You may also find that some topical formulations work better on certain areas of your body. For example, people often use foam medication for scalp psoriasis and a lotion on their bodies.
Even when you find the right combination, it’s still likely that your psoriasis will return. But you’ll now have a treatment that works well when your symptoms come back.
How Long Will You Use a Topical?
Topical steroids range in strength from strong (most potent) to weak (least potent). How long you’ll use these medications depends on their strength. You should use super high-potency topical steroids for no more than 3 straight weeks and high- to medium-strength for 12 weeks.
If you need treatment for a longer period, talk to your doctor. They may suggest that you use a high-strength topical steroid less frequently or have you switch to a milder treatment. Once your symptoms have cleared up, you can stop using the medication.
There are other types of topicals, like those without steroids, and ones you can buy over the counter. Talk to your doctor about how long you should use these treatments, and carefully follow all instructions included with the medication.
When Should You Stop Taking a Topical?
Finding the right treatment, or combination of treatments, can be a time-consuming process. Sticking with treatment can be hard, but not following through is one of the biggest barriers to success. It’s crucial to follow your doctor’s instructions to see improvement in your symptoms.
It’s also important to keep using a topical steroid until you get your doctor’s OK to taper off the medication. If you suddenly stop, it can cause your psoriasis to get worse. It can also trigger a side effect known as topical steroid withdrawal (TSW). TSW happens when you abruptly stop taking a topical steroid instead of tapering off. It can cause a burning feeling, flaking, swelling, and other skin symptoms.
Photo Credit: Tetra Images / Getty Images
Cleveland Clinic: “Psoriasis,” “Retinol.”
National Psoriasis Foundation: “Topicals,” “Steroids,” “Over-the-Counter Topicals,” “Non-Steroidal.”
UpToDate: “Treatment of psoriasis in adults.”
American Family Physician: “Topical Corticosteroids: Choice and Application.”
Mayo Clinic: “Psoriasis.”
Gabros S, Nessel TA, Zito PM. “Topical Corticosteroids,” StatPearls Publishing, 2023.
National Eczema Association: “Topical Steroid Withdrawal: What the Eczema Community Needs to Know, Now.”