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There is a wide selection of both prescription and non-prescription topical treatments available and they work in different ways, but it's believed that some may help slow the abnormally rapid growth of skin cells and reduce the inflammation (redness) commonly found with psoriasis.
Topical treatments
A topical medication is one used externally, which means it is applied directly to the skin rather than taken internally and affects only the area where it is applied.
Dermatologists usually turn to topical treatments, or "topicals," first for the management of psoriasis. They range from over-the-counter treatments, including remedies based on coal tar, to prescription steroids. Notably, the affected areas of the skin can become less responsive to treatment over time, particularly when topical corticosteroids are used.
There is a wide selection of both prescription and non-prescription topical treatments available and they work in different ways, but it's believed that some can help slow the abnormally rapid growth of skin cells and reduce the inflammation (redness) commonly found with psoriasis.
To enhance the absorption of a topical, your dermatologist may recommend occlusion—the process of covering the affected area in a closed, airtight dressing after applying the medication. It is important to discuss this method with your dermatologist because there are possible side effects such as thinning of the skin, increased skin sensitivity, systemic absorption, as well as other risks.
Over-the-counter topicals
You can purchase a variety of psoriasis treatments over the counter. Additionally, many over-the-counter moisturizers, bath and shower oils, and natural salt products may all help lubricate dry skin and decrease redness and itching.
Moisturizers—It's important to keep psoriasis skin moisturized on a daily basis to help reduce redness, itching and promote healing. Over-the-counter creams and ointments that are oil-based work well to lock water into the skin.
Coal tar preparations—Tar products help relieve the itching, redness and scaling in plaque psoriasis. Tar products can be used on both skin and scalp psoriasis and can be messy, stain clothing and have an unpleasant odour which some people might find disagreeable. Adverse reactions include skin redness, stinging, atrophy and pigment changes.
Keratolytics (salicylic acid)—Salicylic acid is available with or without a prescription for the treatment of psoriasis. It's often used to remove the thick scales covering the plaque psoriasis and may enhance absorption of other topical drugs so that they can better penetrate the skin. Strong salicylic acid preparations may cause localized skin irritation if they come into contact with normal skin or if left on the skin too long.
Anthralin—Also called dithranol, anthralin comes from Goa powder, which is found in the bark of the Brazilian araroba tree, and has been used to treat the inflammation and itching of psoriasis since the mid-1800s. The side effects may include irritation and inflammation to normal skin. And it can be messy to use and may stain unaffected skin as well as clothing. Anthralin cream is rarely used today.
Prescription topicals
Some treatments are available by prescription only. A few of the more common ones are listed below.
Topical retinoids (Tazarotene)—A topical retinoid (prescription vitamin A derivative) used to treat plaque psoriasis. Tazarotene can provide improvement by slowing the growth of skin cells and reducing inflammation. It can cause skin irritation, redness, burning, itchiness, and is not recommended for use by pregnant women.
Topical steroids (corticosteroids)—Among the topical treatments most often prescribed for psoriasis, corticosteroids can reduce inflammation and skin cell turnover and also suppress the immune system. They clear up lesions quickly. Adverse effects depend on the potency of the preparation, the duration, frequency and site of application. Dryness, itching, burning, irritation and atrophy (deterioration) of skin cells and tissues under the skin have been reported in some patients. Use of strong corticosteroids may result in thinning of the skin and internal side effects when used for long periods of time or on thin skin (e.g. the face), and some people may build resistance.
Vitamin D analogs (calcipotriene)—A human-made form of vitamin D3, calcipotriene is used to treat psoriasis by slowing the rate of abnormal skin cell reproduction, improving redness, flatten lesions, and remove scales. Patients usually see results after 2 weeks. It may take between 6 and 8 weeks to see a full effect. The most common side effect is skin irritation, including burning and itching. Calcipotriene is available as an ointment, cream, and a scalp solution.
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