Topical Treatments for Psoriasis

Recommended Over-the-Counter and Prescription Remedies

woman applying cream to rash on arm
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Topical therapies are the mainstay of psoriasis treatment. They are typically used before oral or injectable drugs to help alleviate dryness, flaking, itching, and inflammation. Topical therapies can also support medications like methotrexate or biologic drugs like Enbrel (etanercept) or Humira (adalimumab) in people with moderate to severe psoriasis.

Some of the topical remedies are available over the counter, while others require a prescription. Be sure to speak with your doctor before incorporating any over-the-counter (OTC) product into your treatment plan. Some can irritate the skin if not used appropriately and may even trigger a flare.

Emollient Moisturizers

Moisturizers are important in any stage of treatment. Those rich in emollients can help lock moisture in and significantly reduce dryness, itching, and flaking. There are a number of options to choose from, including creams, ointments, lotions, gels, bath oils, and sprays.

For mild to moderate psoriasis, moisturizers made with petrolatum (white soft paraffin) are often very helpful. Not only are they long-lasting, but they tend to less greasy than products made with castor oil, cocoa butter, or vegetable oils.

Although heavier moisturizers may be needed for moderate to severe cases. vegetable-oil-based products can oxidize if left on the skin for too long. Speak with your dermatologist about the proper use of these moisturizers to avoid inflammation.

Other emollient types include isopropyl palmitate, liquid paraffin, polyethylene glycol, shea butter, stearic acid, and stearyl alcohol. 

Hydrocortisone Cream

For most people, over-the-counter corticosteroid creams are the first line of defense against the pervasive itch of psoriasis. Hydrocortisone 1% cream is the most commonly used OTC anti-itch medication. Stronger formulations are available by prescription. Side effects include tingling, burning, acne, and changes in skin color.

Hydrocortisone can be highly effective over the short term. According to a 2014 study in the Journal of the American Academy of Dermatologya four-week course of topical hydrocortisone cream (applied twice daily) reduced the size psoriasis lesions by nearly 20 percent and the severity of symptoms from a Target Lesion Score (TLS) of 8 (meaning severe) to a TLS of 2 (meaning mild). 

Topical corticosteroids are not recommended for prolonged use as they may cause irreversible skin atrophy (thinning). Never use topical corticosteroids on your face unless your dermatologist tells you to.

Salicylic Acid

Salicylic acid is used in a wide range of OTC skin care products, including acne medications, face washes, soaps, and dandruff shampoos. It works by gently removing dead cells from the surface of the skin and promoting better absorption of other topical medications.

The U.S. Food and Drug Administration (FDA) has approved the use of salicylic acid for the treatment of psoriasis. The medication, classified as a keratolytic, can sometimes cause redness and irritation, particularly if overused. Ask your dermatologist whether an OTC brand is appropriate or if a prescription formulation is needed for more severe lesions.

Coal Tar

Coal tar is a centuries-old remedy of psoriasis, eczema, and other skin disorders. It is known to reduce inflammation and slow the hyperproduction of skin cells that causes skin plaques. Coal tar-containing products come in a variety of formulations, including lotions, shampoos, and foams.

Coal tar preparations are generally left on the skin for at least two hours and are sometimes combined with phototherapy to increase the skin's sensitivity to ultraviolet (UV) rays.

Coal tar is available over the counter and by prescription. Side effects are rare but may include skin irritation and redness. Coal tar can also stain clothing and leave behind a strong odor for an hour or two after treatment. There are some decolorized and deodorized coal tar products, but it is unclear how well these work compared to crude coal tar.

Vitamin D Analogs

Topical vitamin D analogs are man-made versions of vitamin D that help temper the hyperproduction of skin cells. They are safer than hydrocortisone for long-term use but may cause burning, stinging, and redness. Applying a thin layer of moisturizer beforehand can sometimes help.

Vitamin D analogs come in a variety of lotions, creams, foams, and topical solutions. They are available by prescription and marketed under different brand names:

  • Calcipotriene (brand names Calcitrene, Dovonex, and Sorilux)
  • Calcitriol (brand names Rocaltrol and Vectical)
  • Tacalcitol (brand names Bonalfa and Curatoderm)

Vitamin D analogs are sometimes co-formulated with topical corticosteroids for two-in-one treatment. This includes the drugs Enstilar and Taclonex which combine calcipotriene with betamethasone.

Anthralin

Anthralin cream is one of the first topical medications developed to treat psoriasis and one that is still occasionally used to treat moderate to severe psoriasis. It works by slowing the growth of skin cells and easing inflammation. Anthralin doesn't have any serious side effects but can cause irritation and the staining of clothing, towels, and skin.

Anthralin is available by prescription as a cream or shampoo under a variety of brand names, including Drithocreme, Dritho-Scalp, Psoriatec, and Zithranol.

To reduce the risk of irritation, anthralin cream should be used no more than once daily and for no longer than 30 minutes per treatment.

Tazarotene

Retinoids are are a form of vitamin A that slows the growth of skin cells while promoting the shedding of dead skin cells. Tazarotene 0.1% cream is the topical version used to treat psoriasis.

Available by prescription and sold under the brand names Avage, Fabior, Tazorac, and others, tazarotene may be applied to the face and other skin. Foams and gels are available to treat scalp psoriasis.

Tazarotene can be irritating to the surrounding skin. To avoid unnecessary exposure, apply petroleum jelly around the lesions before carefully dabbing on the cream.

It is important to avoid sun exposure when using tazarotene as it can increase light sensitivity and promote sunburn.

Calcineurin Inhibitors

Calcineurin inhibitors are immunosuppressant drugs that block a chemical called calcineurin that the body uses to instigate the inflammatory response. The two topical formulations, Elidel (pimecrolimus) and Protopic (tacrolimus), are approved by the FDA to treat eczema but are commonly used off-label to treat psoriasis.

According to a 2014 review of studies in the Journal of Cutaneous Medicine and Surgery, topical calcineurin inhibitors were not only effective in treating psoriasis but were able to do so without many of the side effects of topical corticosteroids.

Available by prescription, topical calcineurin inhibitors may cause itching, redness, burning, and sensitivity to cold or heat. Less commonly, headache, nausea, folliculitis, and flu-like symptoms may occur. 

In 2005, the FDA issued a black box warning, advising consumers that there may be a link between calcineurin inhibitors and lymphoma (a type of blood cancer) or skin cancer.

For its part, the American Academy of Dermatology insists that a causal link has yet to be established and that the risk is at best minimal.

Alternative Remedies

There are a number of alternative topical therapies used to treat psoriasis, some of which have little evidence to support their use. This includes aloe vera, which has a soothing effect but contributes little to resolving the underlying condition, and jojoba, which may reduce local inflammation.

One topical drug that may be useful is capsaicin, a neuroactive compound derived from chili peppers. Available over the counter (in creams, lotions, and patches) and by prescription (in patches), capsaicin is known to block pain signals from the skin and muscles to the brain.

Despite evidence of its benefit in treating musculoskeletal and neuropathic pain, little research has been devoted to its use in treating psoriatic pain.

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