Rutledge Forney, M.D. Medical, Surgical, and Cosmetic Dermatologist
Topical Treatments for Psoriasis
Topical treatments are rubbed directly into the affected skin to bring local relief without the system-wide side effects of medicines taken by mouth or a shot. Topical treatments for psoriasis include:
- Salicylic acid . Some doctors recommend salicylic acid ointment, which smoothes the skin by promoting the shedding of psoriatic scales. Using salicylic acid over large areas of skin, however, may cause the body to absorb too much of the medication, leading to side effects. Salicylic acid may also cause skin irritation and weaken hair shafts, which can cause breakage and temporary hair loss. The effectiveness of these preparations are modest at best.
- Steroid-based creams. The mainstay of psoriasis treatment, steroid creams decrease inflammation, relieve itching, and block the production of cells that are overproduced in psoriasis. Stronger preparations, which are more effective than milder ones, can cause side effects that include burning, dryness, irritation, and thinning of the skin. Be especially careful to follow your doctor's instructions on their use.
- Calcitriol (Vectical) and Calcipotriene (Dovonex, Sorilux) containing topical ointment. These have proven to be effective for treating psoriasis, especially when combined with a topical corticosteroid cream. It's best to use only limited amounts to avoid side effects.
- Coal-tar ointments and shampoos. These products can help slow the rapid growth of skin cells and alleviate symptoms, but some people are vulnerable to the side effects, especially folliculitis, a pimple-like rash affecting the hair follicles. These medicines should be used only under a doctor's supervision.
- Prescription retinoids. These topical preparations containing a synthetic form of vitamin A can help improve psoriasis. These preparations don't work as quickly as steroids. Topical retinoids can sometimes cause dryness and irritation of the skin.
Phototherapy for Psoriasis
Even regular doses of sunlight -- not enough to produce sunburn -- can help psoriasis lesions in many people. For persistent, difficult-to-treat cases of psoriasis, many doctors recommend light therapy.
- PUVA (the drug psoralen combined with ultraviolet A, or UVA, light). This is one of the most effective treatments. However, this form of therapy is used far less often today, because it has been shown to increase the risk of developing skin cancer -- even decades after stopping this therapy.
- Ultraviolet B light (UVB) light. Some doctors may prescribe this treatment using a light box alone, or with other therapies such as coal tar.
- Narrow-band UVB therapy. This more targeted ultraviolet light treatment is less likely to cause cancer than PUVA and is almost as effective.
Oral and Injectiable Medications for Psoriasis
When other treatments fail, some doctors prescribe oral or injectable drugs to treat psoriasis. Some of these medications affect the immune system.
- Methotrexate. This medication is also used as a chemotherapy drug for cancer and for various forms of arthritis. It can dramatically clear up psoriasis lesions. However, it can cause side effects, so your doctor will have you come in for regular blood tests.
- Oral retinoids. These compounds with vitamin-A-like properties can be mildly helpful to people with severe psoriasis. Women of childbearing age need to use birth control with this medication because it is linked with an increased risk for birth defects.
- Biologics . These medications control your body’s immune response. They’re often used to treat severe psoriasis and psoriatic arthritis. These drugs, which are made from human or animal proteins, are quite effective but extremely expensive. They include adalimumab (Humira), brodalumab (Siliq), certolizumab pegol (Cimzia), etanercept (Enbrel), guselkumab (Tremfya), infliximab (Inflectra, Remicade, Renflexis), ixekizumab (Taltz), risankizumab-rzaa(SKYRIZI),secukinumab (Cosentyx), tildrakizumab (Ilumya), and ustekinumab (Stelara). Another drug, apremilast (Otezla), has been found to be effective in reducing joint pain and psoriatic skin symptoms. It works by suppressing an enzyme involved in inflammation.
Natural Psoriasis Treatments
If medications fail to relieve the symptoms of psoriasis or cause unwanted side effects, people may try natural remedies, such as herbs and vitamins, for relief. Some people with psoriasis find natural sunlight and ocean water helpful. Some seaside resorts offer special programs for people with psoriasis.
If you are considering natural remedies for psoriasis, here's what you should know about some of the more commonly used remedies:
- Dead Sea salts. Bath solutions, such as Dead Sea salts, oil, oilated oatmeal, or Epsom salts can help psoriasis by removing scales and easing itching. To try Dead Sea salts and other bath solutions, mix them in the bath as directed, then soak in the tub for about 15 minutes. As soon as you get out of the tub, apply a moisturizer to the skin. Don't expect a lot of improvement, however.
- Aloe vera. Preliminary research suggests that topical cream from the aloe vera plant may improve symptoms of psoriasis. One study showed that topical aloe vera was more effective than placebo. This product is of only minimal benefit, at best.
- Fish oil. Fish oil may be helpful for psoriasis when taken as an injection by vein, but it doesn’t seem to have a positive effect when taken by mouth. However, some research showed that it might give added benefit to UVB light therapy.
- Cayenne. Cayenne peppers have been used medicinally for thousands of years. Capsaicin, the ingredient in peppers that gives them their heat, is also the active ingredient in many pain-relieving gels and creams. In one study, applying capsaicin cream to the skin relieved itching and skin lesions in people with psoriasis. Capsaicin can cause a burning sensation to the skin, which improves the longer you use it. It's important to wash your hands immediately after rubbing in capsaicin and not touch your eyes or mouth while you have capsaicin on your hands.
- Diet. Obese psoriasis patients who lose weight report significant improvement in their symptoms, some research has shown.Evidence is lacking that other dietary restrictions such as gluten-free make any difference in the symptoms of psoriasis.