Topical treatments applied to the skin are the most commonly-used therapy for psoriasis. In fact, about 70 to 80 percent of patients will experience good results with creams, lotions, gels and other formulas. For those who treat their psoriasis with pills or light treatments, topical therapies may continue to be used on stubborn areas.
Here is a list of recommended treatments for psoriasis:
Topical corticosteroids are typically a first-line treatment strategy for psoriasis. They range in strength from over-the-counter preparations like hydrocortisone to prescription-strength drugs such as clobetasol, halobetasol, betamethasone and diflorasone.
Topical corticosteroids are available in several different formulas. Ointments are the most effective, but many people use them only at night because they tend to have a greasy feel. Creams are a more pleasant option for daytime use, while foams and gels work well on the scalp and other areas with lots of hair.
Possible side effects associated with chronic and prolonged use of topical corticosteroids include skin atrophy, stretch marks and red spots. Rarely, heavy long-term use can cause a suppression of the adrenal glands. Additionally, resistance can develop if steroids are used over an extended period of time. In an effort to reduce the risk of side effects and resistance, your doctor may recommend that you take periodic breaks from the drug. A safe dose should not exceed more than 50 or 60 grams a week.
Vitamin D Compounds
Though topical corticosteroids are typically first line therapy for psoriasis, research has shown comparable success with other topical therapies such as vitamin D compounds. However, there is an increased risk of side effects. Calcipotriene, a synthetic form of vitamin D, reduces the excess production of skin cells associated with psoriasis. It is available as an ointment, cream or solution and is effective in about two-thirds of those who use it.
The main side effect of calcipotriene is skin irritation, so it should not be used in combination with corticosteroids. A safe dose is less than 120 grams a week. If used in conjunction with light therapy for psoriasis, this treatment should be applied afterwards, as light therapy inactivates vitamin D compounds.
Topical retinoids are vitamin A derivatives and have been used to treat mild to moderate psoriasis. Despite the proven clinical efficacy of these agents in the treatment of psoriasis, it remains unknown how they work. Like vitamin D, research has also shown that they, too, are just as effective as topical corticosteroids but with slightly increased side effects. The most common side effects are local irritation and increased sun sensitivity, which is fairly mild and can be prevented by proper use and application. There are three FDA-approved topical retinoids available in the United States: tretinoin, adapalene and tazarotene. Topical corticosteroids are often prescribed with retinoids because they may reverse some of the skin thinning corticosteroids can cause. Conversely, corticosteroids can help with skin irritation caused by tazarotene.
Coal Tar and Anthralin
Coal tar and anthralin are safer than corticosteroids, but are not used as often because they have limited effectiveness, irritate the skin, have an unpleasant odor and can stain skin and clothing. Coal tar is available in medicated shampoos and bath preparations, while anthralin is usually applied for 15 to 30 minutes and then thoroughly rinsed off with lukewarm water to reduce staining. Coal tar ointment is sometimes combined with ultraviolet B light therapy in a three-week regimen called Goeckerman treatment.
Salicylic acid is sometimes added to psoriasis creams because it removes scales from the skin. It can be used with corticosteroids, coal tar or anthralin. However, it has been shown to inactivate calcipotriene.
Letting It Sink In
If you are currently using a topical treatment for psoriasis, be sure to follow your doctor's instructions explicitly. If not, be sure to talk with your doctor to find out if any of these options will help you look and feel your best.