What is the topical treatment for psoriasis?
Treatments applied directly to the skin may improve its condition. Doctors find that some patients respond well to ointment or cream forms of corticosteroids, vitamin D3, retinoids, coal tar, or anthralin. Bath solutions and moisturizers may be soothing, but they are seldom strong enough to improve the condition of the skin. Therefore, they usually are combined with stronger remedies. Doctors usually use medications applied to the skin first to treat psoriasis. These medications are most useful for treating mild to moderate psoriasis. The medication that is best may depend on the type and location of the
psoriasis. For example, ointments may be very effective for thick, flaky plaques on the body but messy and uncomfortable on the scalp.
Corticosteroids. These drugs reduce inflammation and the turnover of skin cells, and they suppress the immune system. Available in different strengths, topical corticosteroids (cortisone) are usually applied to the skin twice a day. Short-term treatment is often effective in improving, but not completely eliminating, psoriasis. Long-term use or overuse of highly potent (strong) corticosteroids can cause thinning of the skin, internal side effects, and resistance to the treatment's benefits. If less than 10 percent of the skin is involved, some doctors will prescribe a high-potency corticosteroid ointment. High-potency corticosteroids may also be prescribed for plaques that don't improve with other treatment, particularly those on the hands or feet. In situations where the objective of treatment is comfort, medium-potency corticosteroids may be prescribed for the broader skin areas of the torso or limbs. Low-potency preparations are used on delicate skin areas.
Topical steroid medications are one of the most common treatments for mild to moderate psoriasis. They reduce redness (inflammation) and itching and stop the rapid build-up of dead skin cells. They come in varying strengths, from weak to highly potent and are available as creams, gels, lotions, ointments, or solutions. Generally stronger preparations are used on the scalp, knees, palms and feet while weaker creams or ointments are used on the face and other sensitive areas. A new foam for scalp psoriasis called clobetasol propionate has recently been approved. In foam form, it penetrates the skin easily - enhancing the effectiveness of the treatment.
Topical steroids can become less effective if used repeatedly for a long time. This is called resistance. The best outcome may be achieved when topical steroids are combined with other medications applied to the skin. However, steroid medication should not be stopped suddenly. Steroids in the form of pills or injections are generally not used to treat psoriasis because they have too many serious side effects. Long-term use of potent topical steroids on large areas of skin can produce side effects such as stretch marks, thinning and skin color changes, plus the appearance of small blood vessels through the skin. These medications should not be put on the face or on areas of the body where the skin folds, such as the armpits, groin, and between the toes.
Tar compounds. Crude coal tar is a byproduct of oil production. It makes the skin more sensitive to light. In its natural state it is a thick, brownish-black substance that is messy to apply to the skin. Refined coal tar preparations, many of which are available over the counter, may be more cosmetically acceptable. Coal tar has been used for more than 100 years to treat psoriasis and it has few side effects. However, it does not work for everyone. In addition to being messy to use, it has a strong odor and can stain skin and clothing. Coal tar can be combined with ultraviolet light treatment in the Goeckerman regimen for treating severe psoriasis. This regimen, developed at the Mayo Clinic, combines tar with gradually increasing exposure to ultraviolet light, which vary depending on the severity of the psoriasis and skin sensitivity. The regimen is usually performed daily in a supervised medical setting.
Anthralin. Anthralin reduces the increase in skin cells and inflammation. Doctors sometimes prescribe a 15- to 30-minute application of anthralin ointment, cream, or paste once each day to treat chronic psoriasis lesions. Afterward, anthralin must be washed off the skin to prevent irritation. This treatment often fails to adequately improve the skin, and it stains skin, bathtub, sink, and clothing brown or purple. In addition, the risk of skin irritation makes anthralin unsuitable for acute or actively inflamed eruptions. Anthralin is a synthetic medication that has an effect on enzymes in the skin cells of people with psoriasis. It comes in a variety of strengths and in the form of an ointment, cream, or paste. Generally it works best on people with plaque and guttate forms of psoriasis and it can be used with ultraviolet therapy. Side effects include irritation of normal skin. In the past, old formulations of anthralin temporarily stained skin, clothing, and furniture purplish-brown. However, a new mixture of anthralin does not stain household items. It is applied to the skin at body-surface temperature. Warm water releases the active ingredient in this product, so it should be washed out with cold water. Over a period of weeks, redness and scales decrease and plaques gradually flatten. In the Ingram regimen, anthralin paste is applied to widespread plaques of psoriasis. This is followed by a tar bath and ultraviolet light treatment. This regimen produces significant clearing in about three weeks at a supervised day-treatment center.
Calcipotriene (Vitamin D). Synthetic vitamin D is also called calcipotriol or calcipotriene and is a chemical cousin of Vitamin D3. It is odorless and non-staining. It can be used alone but often works best in combination with other topical agents or phototherapy. This drug is a synthetic form of vitamin D3 that can be applied to the skin. Applying calcipotriene ointment twice a day controls the speed of turnover of skin cells. Because calcipotriene can irritate the skin, however, it is not recommended for use on the face or genitals. It is sometimes combined with topical corticosteroids to reduce irritation. Use of more than 100 grams of calcipotriene per week may raise the amount of calcium in the body to unhealthy levels. Applying the medication twice a day reduces scales by controlling the build-up of dead skin cells. Calcipotriene is most effective for mild to moderate psoriasis. It can irritate the skin and is not recommended for use on the face or genitals. Calcipotriene's safety for the treatment of psoriasis that affects more than 20 percent of the skin is unknown. Using it on widespread areas of the skin may raise the amount of calcium in the body to unhealthy levels. Vitamin D3 is not the same as the Vitamin D found in over-the-counter vitamin supplements. Vitamin D3 should not be taken by mouth because it may raise blood calcium levels and increase the risk of kidney stones. It should be used with caution in children.
Retinoids. These prescription medications are chemical cousins of Vitamin A and are used to treat a variety of skin conditions. Topical retinoids are synthetic forms of vitamin A. The retinoid tazarotene (Tazorac) is available as a gel or cream that is applied to the skin. If used alone, this preparation does not act as quickly as topical corticosteroids, but it does not cause thinning of the skin or other side effects associated with steroids. However, it can irritate the skin, particularly in skin folds and the normal skin surrounding a patch of psoriasis. It is less irritating and sometimes more effective when combined with a corticosteroid. Because of the risk of birth defects, women of childbearing age must take measures to prevent pregnancy when using tazarotene. Tazarotene is a synthetic retinoid introduced to treat mild to moderate plaque psoriasis, and psoriasis of the scalp and nails. Tazarotene clears skin more slowly than topical steroids but has fewer side effects. It may be used in combination with topical steroids or ultraviolet light treatment. Introduced in gel form, it is now available in a cream that may be better tolerated. Tazarotene clears skin more slowly than topical steroids but has fewer side effects. It may be used in combination with topical steroids or ultraviolet light treatment. Tazarotene can be irritating to normal skin and should be used with caution in skin folds. Like other retinoids, tazarotene can cause birth defects. Pregnant women must not use it. Women of childbearing age who use it must also use an effective method of birth control.
More information on psoriasis
What is psoriasis? - Psoriasis is a disease whose main symptom is gray or silvery flaky patches on the skin which are red and inflamed underneath when scratched.
What types of psoriasis are there? - Types of psoriasis include plaque psoriasis, guttate psoriasis, pustular psoriasis, erythrodermic psoriasis, flexural psoriasis, psoriatic arthritis, and nail psoriasis.
What causes psoriasis? - Psoriasis is driven by the immune system. Psoriasis is the growth of too many skin cells. The first outbreak of psoriasis is often triggered by emotional or mental stress or physical skin injury.
How is psoriasis diagnosed? - Physicians diagnose psoriasis by examining the affected skin. In people with psoriatic arthritis, the arthritis usually follows the appearance of psoriasis.
What triggers psoriasis? - Psoriasis triggers include streptococcal infection, sun exposure, drug reactions, hormonal factors, psychological factors, and skin trauma.
What are the psoriasis symptoms? - Symptoms depend on the type of psoriasis the individual has and may include bright red areas of raised patches (plaques) on the skin, tiny areas of bleeding, and itching.
What are the psoriasis risk factors? - The risks associated with developing psoriasis are similar to the triggers of the disease. The most significant risk factor for psoriasis is a family history of the condition.
What is the treatment for psoriasis? - The treatment is chosen on the basis of the pattern of psoriasis and its severity. Treatments for psoriasis can often control the disease for long periods.
What is the topical treatment for psoriasis? - Some patients with psoriasis respond well to ointment or cream forms of corticosteroids, vitamin D3, retinoids, coal tar, or anthralin. The medication that is best may depend on the type and location of the psoriasis.
What is the phototherapy treatment for psoriasis? - Phototherapy treatment for psoriasis uses ultraviolet (UV) light to kill T cells in skin, reducing redness and slowing the overproduction of skin cells that causes scaling.
What is the systemic treatment for psoriasis? - Systemic treatment for psoriasis involves taking medicines internally by pill or injection. Systemic psoriasis treatment drugs include methotrexate, retinoids, cyclosporine.
What is plaque psoriasis? - Plaque psoriasis can is a disease with very clearly defined area of skin which has a raised, red and inflamed section of skin covered in silvery scales.
What is guttate psoriasis? - Guttate psoriasis is a type of psoriasis that looks like small, salmon-pink drops on the skin. Guttate psoriasis is characterised by multiple tiny areas of psoriasis.
What is flexural psoriasis? - Flexural psoriasis is a form of psoriasis found in the armpits, groin, under the breasts and in other flexion creases (skin folds) such as those around the genitals and buttocks.
What is pustular psoriasis? - Pustular psoriasis is an uncommon form of psoriasis. People with pustular psoriasis have clearly defined, raised bumps on the skin that are filled with pus (pustules).
What is erythrodermic psoriasis? - Erythrodermic psoriasis is a particularly inflammatory form of psoriasis that often affects most of the body surface. Erythroderma is a generalised redness of the skin.
What is scalp psoriasis? - Scalp psoriasis range from very mild with fine scaling to very severe with thick, crusted plaques. Scalp psoriasis scales appear powdery with a silvery sheen.