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 -- 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.

Types of 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.

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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.

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. 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. 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.

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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 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).

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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..

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) 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.

Moisturizers for PsoriasisPsoriasis shows up in different ways from head to toe. Find out which moisturizers are best for specific parts of your body.100

[MUSIC PLAYING]

JODI GANZ: It's important to use

moisturizer for psoriasis

because psoriasis is a very dry,

flaky condition, and the number

one complaint I get from people

is that they have flakes all

over their clothes.

So what the moisturizer does

is it helps to hydrate the skin,

make that flaking less

noticeable,

prevent the cracking

and the itching that can go

along with that dryness.

Psoriasis can go all the way

down from the head to the toes.



In the scalp, I'll usually

recommend a thinner oil

or a spray that tends to spread

evenly in the hair.

On the body, the elbows,

the knees, I'm going to want

a thicker, more hydrating

base-- something

like an ointment.

On body surface areas

like the chest,

if it's a hair-bearing area,

we'll even use foams

and they spread real easily

on areas like that.



I will say that salicylic acid,

which is often an ingredient

in different moisturizing

creams,

can be helpful to exfoliate

that scale.

I have had people use olive oil,

jojoba oil, lavender oil.

All of these are nice,

easy-to-spread bases.

They're not very hydrating.



So oftentimes, if I'm going

to recommend an oil, I'll also

have a patient use a thicker

cream of ointment with it.

But in general, an ointment

is going to be more

hydrating than a cream.

A cream is going to be more

hydrating than an oil.



Psoriasis is

a chronic condition,

and I think it's best treated

when you're doing maintenance

therapy daily.

I always recommend

to my patients

a good moisturizer every day

after the bath or shower when

their skin is a little bit damp

is the best way

to stay ahead of it.



[MUSIC PLAYING]

Jodi Ganz, MD<br>Olansky Dermatology/delivery/85/6c/856c609d-c07f-4299-9f47-51f5b58328d2/vd-1384-ah-moisturizers-for-psoriasis_,4500k,750k,2500k,1000k,400k,.mp412/28/2017 13:03:00650350olive oil/webmd/consumer_assets/site_images/article_thumbnails/video/moisturizers_for_psoriasis_video/650x350_moisturizers_for_psoriasis_video.jpg091e9c5e815df2e3

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.

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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.

Injection Tips for Moderate to Severe PsoriasisShots are a great option for people who have moderate to severe psoriasis. Find out what you should know.106

[MUSIC PLAYING]

JOSEPH PAYNE: There are

multiple treatment options

for patients

with moderate to severe plaque

psoriasis.

And for some patients,

injections are the best method.

If your disease is greater

than approximately 5%

of your body's surface,

and, certainly, if it's

beyond say 10%,

this is something that you

should definitely

be entertaining as an option.



These medicines are kind

of tinkering

with your immune system

slightly.

You should be thinking about,

is this going to make

my immune system function

in a way

other than how it's supposed to?



The things that we're really

concerned about is infection

risk.

It is something that you just

kind of have to watch in terms

of the either number, frequency,

duration, or severity.

For the most part, we're talking

about bacterial infections,

things like staph infections,

urinary tract infections.

But you also have

mycobacterial infections

like tuberculosis.



For most people, they're not

going to notice any difference

in the number of infections

that they see.

We recommend to patients who

either have immune disorders

or perhaps they are in the midst

of battling a cancer to not

be on these biologic medicines,

and so we try to find

other alternatives.



The medicines do such a good job

of keeping things under control,

the patients sometimes feel as

though they're cured.

So my advice would be, stay

on schedule

with their injections,

regardless of how well

their psoriasis is responding.

Joseph R. Payne, MD<br>Dermatologist, Dermatology Association of Atlanta /delivery/aws/cd/e8/cde8310b-bbf3-3325-aec3-56b31c0132bf/funded-expert-feature-psoriasis-injection-tips_,4500k,2500k,1000k,750k,400k,.mp412/11/2019 12:00:0018001200photo of psoriasis on hands/webmd/consumer_assets/site_images/article_thumbnails/video/psoriasis_injection_tips_video/1800x1200_psoriasis_injection_tips_video.jpg091e9c5e81dcfa58
WebMD Medical Reference Reviewed by Brunilda Nazario, MD on October 07, 2020

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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