Psoriasis Cream Medications

Most patients with psoriasis covering only a small portion of their bodies can usually get their condition under control with topical treatment. Topicals are creams, gels, or other medications applied directly to the skin. There are several different types of topical treatments available. Common topicals for psoriasis include hydrocortisone, betamethasone, calcipotriene (Dovonex and generics), clobetasol, halobetasol, and tazarotene (Tazorac).

The most common drugs used in a topical preparation are corticosteroids. These steroids are not to be confused with the type of steroids that make you grow muscles. They are used on the skin for psoriasis for their anti-inflammatory action. They reduce swelling and redness in the lesions.

Cortisone creams come in many strengths (classes), and higher strengths require a prescription. The stronger the cortisone, the lower the class. Class 1 steroids are exponentially stronger than Class 7 steroids. Different strengths are more appropriate for different areas of the skin and for various conditions.

Hydrocortisone is the mildest of the steroid creams and is available over-the-counter (OTC) in a 1 percent strength. It is a class 7 steroid, with some variations as potent as class 5. Psoriasis, however, is often too stubborn to treat with OTC hydrocortisone alone.

Strong steroid creams, such as clobetasol and halobetasol, 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 tend to thin the skin over time. Covering large areas of the body with strong steroids can suppress the body's natural cortisol production, reducing your ability to cope with stresses like infection, injury or surgery. Always ask your doctor exactly where you are and are not supposed to apply any topical.

We can lump anything that's not a steroid into this group.

• Vitamin D Analogues: Vitamin D-derived Dovonex (calcipotriene) and Rocaltrol (calcitriol) 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 the DNA to normalize cell growth and maturation. However, they also can irritate the skin and make skin 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 and must be used 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 for atopic dermatitis. These are used for sensitive areas of the face and groin or areas of inverse psoriasis in the skin folds.

The side effects of the non-steroids are typically less worrisome than their steroid cousins, but they are also usually slower acting or less potent. Recently, an ointment combining a steroid with Taclonex (calcipotriene) was introduced in order to get the benefits of both classes of drugs while minimizing the side effects.

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.