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 topical treatments -- meaning you put them directly on your skin or scalp.
You can get some over the counter (OTC) at the drug store, but you'll need a prescription for others. It may take time to find what works best for you.
Over-the-Counter (OTC) Topicals
Moisturizers and emollients you buy without a prescription can help control flare-ups. In general, thick, greasy lotions, creams, and ointments that trap moisture in your skin work best.
Salicylic acid gets rid of scales that show up on patches of psoriasis. It comes in lotions, creams, ointments, foams, gels, soaps, shampoos, liquids, cloth pads, and patches. It's especially helpful when it’s used with other skin treatments. Removing flakes of dead skin lets other medications work better.
Coal tar can help slow the growth of skin cells and make your skin look better. It also comes in many different forms, including shampoo to treat scalp psoriasis. The weaker products are available OTC. Your doctor can prescribe a stronger version if you need it.
But coal tar doesn't smell good, and it can irritate your skin and stain your clothes. And you’ll need to follow the directions carefully. Some studies show that chemicals in coal tar can lead to cancer but only at very high doses. It's safe to use these products if you follow your doctor's instructions.
Mild steroids (corticosteroids) help with 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 your face or neck or skin-fold areas like your groin or armpit. Stronger corticosteroids require a doctor’s prescription.
Stronger steroids (corticosteroids) work better if you have more than a few small patches of psoriasis, especially in areas that are harder to treat, like knees and elbows.
Steroids sometimes work better when they’re used along with other medications.
Your doctor probably will recommend that you use these twice a day. They may suggest that you wrap the area with tape or plastic after you treat it. This is called occlusion. It can help some treatments work better, but it may also make side effects stronger.
The side effects include:
- Thin skin
- Changes in skin color
- Stretch marks
- Broken blood vessels
Make sure you follow your doctor's directions. Using steroids too often has been linked to serious health problems, including certain kinds of cancer.
Vitamin D analogue topicals have man-made vitamin D in them. These ointments, gels, creams, lotions, foams, and solutions make your skin cells grow more slowly. Over the long-term, they 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 take. Some can stop vitamin D products from working.
Vitamin D analogues include:
- Calcipotriene (Calcitrene, Dovonex, Sorilux)
- Calcitriol (Rocaltrol and Vectical)
- Tacalcitol (Bonalfa and Curatoderm)
Your doctor also may recommend that you use vitamin D along with a steroid. Two combination medications – Taclonex and Enstilar – each contain both calcipotriene (vitamin D) and betamethasone dipropionate (a steroid).
Retinoids, like tazarotene (Tazorac), can help speed up the growth and shedding of skin cells. These foams, gels, or creams are made with vitamin A and come in different strengths. Typically, you put a small dab on the inflamed area and rub it in before bed. (There are OTC retinoids, but not generally for psoriasis.)
Doctors usually don’t recommend these for women who are pregnant or might get pregnant.
Anthralinslows the growth of skin cells and eases inflammation. It doesn't have any serious side effects, but it can irritate your skin and stain clothes, sheets, and skin. It's often used with other medications.
Pimecrolimus (Elidel) and tacrolimus (Protopic) can also help with inflammation. Your doctor may call these drugs calcineurin inhibitors. They're sometimes used to treat psoriasis when other medications don't work.
Be sure to read the FDA warning on the label. There may be a link between calcineurin inhibitors and lymphoma (cancer of the lymphatic system) and skin cancer.
When to Change Things Up
Many topical treatments can bother your skin. So over time, your doctor may suggest that you switch to different types of creams. You may also use them along with other kinds of treatments, like phototherapy or medications you take by mouth or with shots.
And don't be surprised if something that was working stops -- or 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 find the treatment that's right for you.
Before using topical treatments, make sure you understand the directions and the side effects they can cause. And stick with your treatment plan once you start. If you don't use your medication regularly, your psoriasis could get worse.
Find out how to tell if your psoriasis treatment is working.
Bruce E. Strober, MD, PhD, associate director of dermatopharmacology, department of dermatology, New York University School of Medicine; co-director, Psoriasis and Psoriatic Arthritis Center; consultant for Amgen, Biogen, Genentech, Fujisawa, and 3M.
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.
American Academy of Dermatology.
American Academy of Dermatology, PsoriasisNet.
National Psoriasis Foundation.
Abel, E. "Dermatology III: Psoriasis," ACP Medicine, April 2005.