Topical Treatments for Psoriasis

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. That means you put them directly on your skin or scalp.

You can get some over the counter (OTC) treatments at the drug store. But you'll need a prescription for others. It may take time to find what works best for you.

Types of Topicals

Moisturizers and emollients you buy without a prescription can help control flare-ups. In general, thick, greasy lotions 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, gels, soaps, and shampoos. 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.

Coal tar doesn't smell good, and it can irritate your skin and stain your clothes. Also, 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.

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, neck, or skin-fold areas such as your groin or armpit. You may need stronger ones for tough-to-treat places like your elbows and knees. Steroids sometimes work better when they’re used along with other medications.

Your doctor probably will recommend that you use these twice a day. She 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.

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The side effects include:

  • Thin skin
  • Changes in skin color
  • Bruising
  • 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 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:

Your doctor also may recommend that you use vitamin D 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 gels or creams are made with vitamin A and come in different strengths. Typically, you put a small dab on each lesion once a day before bed.

Doctors usually don’t recommend these for women who are pregnant or might get pregnant.

Anthralin slows 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), tacrolimus (Protopic), and crisaborole (Eucrisa) 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 these drugs and lymphoma (cancer of the lymphatic system) and skin cancer.

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When to Change Things Up

Many topical treatments can bother your skin. Over time, your doctor may suggest 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 right treatment 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.

WebMD Medical Reference Reviewed by Debra Jaliman, MD on December 06, 2017

Sources

SOURCES: 

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.

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