Topical Creams for Psoriasis

If your psoriasis only covers a small part of your body, you may be able to get it under control with topical treatment. These are medications that can be applied directly to your skin, right where the problem is.

You've got a lot of choices when it comes to topicals, including, creams, gels, ointments, and more. Common topicals include:

• Hydrocortisone
• Betamethasone
• Calcipotriene (Dovonex and generics)
• Clobetasol
• Halobetasol
• Tazarotene (Tazorac)

Some of these medications contain corticosteroids while others are non-steroidal.

The most common drugs used in a topical preparation are corticosteroids. Don't confuse these steroids with the type of steroids that make you grow muscles, though—they're different.

When they're used in topical preparations, these steroids have an anti-inflammatory action, which means they're good at reducing the swelling and redness that are associated with psoriasis.

Cortisone creams come in many strengths, or classes, and higher strengths require a prescription from your doctor. The stronger the cortisone, the lower the class. 

Class 1 steroids, the strongest ones, are exponentially stronger than Class 7 steroids. Different strengths are more appropriate for different areas of the skin and for various conditions. They're not interchangeable!

Hydrocortisone is the mildest of the steroid creams and is available over-the-counter (OTC) in a 1% strength. It's typically a class 7 steroid but, in some preparations, it may be as potent as class 5 steroid.

Psoriasis, however, is often too stubborn to treat with OTC hydrocortisone alone. For better results, you should talk to your doctor about stronger medication.

Clobetasol, halobetasol, and other strong steroid creams have side effects that are not to be underestimated. They can cause stretch marks to develop in closed areas, such as the armpits and groin, and they tend to thin your skin over time.

Always ask your doctor exactly where you are and are not supposed to apply any topical and make sure you follow the directions. It's not safe to assume that since you can use it in one spot, you can use it everywhere else.

Anything that's not a steroid gets lumped into this group. Common non-steroidal topicals for psoriasis include:

• Vitamin D Analogues: This includes Dovonex (calcipotriene) and Rocaltrol (calcitriol). They can normalize cell growth, slowing down the growth of skin cells.
• Retinoids: Tazorac and Avage (tazarotene) are retinoid drugs derived from vitamin A. They work on your DNA to normalize cell growth and maturation. However, they also can irritate the skin and make it sensitive to sunlight.
• Anthralin: This medication works by slowing down the rapid skin cell growth seen in psoriasis. It also can help make the skin smoother. However, it stains anything it touches, so you'll want to use it carefully.
• Calcineurin inhibitors: Immune modulating drugs, such as Protopic (tacrolimus) and Elidel (pimecrolimus), reduce inflammation without the side effects of steroids. They are used off-label for psoriasis as they are only approved by the U.S. Food and Drug Administration (FDA) for atopic dermatitis. These are used for sensitive areas of the face and groin or inverse psoriasis in the skin folds.

The side effects of the non-steroids are typically less worrisome than their steroid cousins, but these medications are also usually slower-acting or less potent.

Topical drugs for psoriasis come in a dizzying variety, including ointments for dry areas, creams for moist areas, watery liquids, oils, gels and foams for hairy areas, tapes for thickened areas, and sprays for large areas. Whatever area of your body you need to treat, you can be sure there is a product designed just for it. Discuss all of your options with your doctor.