Topical Treatments for Psoriasis
March 01, 2024
![What’s a Topical Treatment?
Topicals are treatments applied directly to skin, scalp, or nails. Often, they’re used as a first course of action for treating psoriasis symptoms, since they’re pretty mild and easy to administer at home with minimal side effects.
Common Forms of Topicals
• Ointments: Made from petrolatum (petroleum jelly) or mineral oil, ointments tend to be thick and greasy. They can prevent moisture loss and stay on top of the skin, ensuring maximum absorption.
• Creams: Made of half oil and half water, creams are lighter than ointments and can treat larger surface areas, since they tend to rub in well.
• Lotions: Even lighter than creams, lotions are made with mostly water and droplets of oil. The thinner consistency allows for easy application and absorption, with little residue. They’re commonly used on the face.
• Oils: Made from alcohol and oil, these allow for easy application on large areas of skin. They’re commonly used for whole-body treatment or overnight scalp treatments.
• Gels: Gels are made from cellulose, water, and alcohol. They’re nongreasy and readily absorbed. They’re useful in hairy areas or for a drying effect.
• Solutions: Made with water and alcohol, solutions allow for rapid absorption and quick drying. They’re generally used for the scalp and can sting or burn due to their high alcohol content.
• Foams: Similar to solutions, foams absorb and dry quickly, allowing for easy application. They’re made with pressurized alcohol and a hydrocarbon propellant to make them bubbly.
Application instructions will vary depending on the topical and your condition, so ask your doctor for specifics.
CORTICOSTEROIDS
(Betamethasone, Hydrocortisone, Triamcinolone)
Available by prescription
Corticosteroids are one of the most common topical treatments for psoriasis. They slow skin growth and reduce swelling and redness. These steroids vary in strength, from very strong (“superpotent”) to very weak (“least potent”). The more potent the steroid, the more effective it is in clearing psoriasis; but, the risk of side effects is greater. Multiple prescriptions may be given based on the location, thickness, and extent of your psoriasis.
Possible Side Effects
● Skin thinning
● Changes in skin pigmentation
● Stretch marks
● Easy bruising
● Redness due to enlarged blood vessels
● Effects to internal organs, if used in large areas for long time (This is very rare.)
VITAMIN D ANALOGUES
(Calcipotriene, Calcitriol)
Available by prescription
Vitamin D analogues may be used alone or with corticosteroids. They normalize skin growth, flatten lesions, and remove scales. They’re commonly used as maintenance treatment to control psoriasis plaques. They can be used on scalp, nails, and body, including where skin rubs together, like the armpits.
Calcitriol is a naturally occurring active form of vitamin D3. It can be used on most areas of the body, except the face, lips, and eyes. It’s important keep it away from pets, as it’s very poisonous and may be fatal if eaten by a dog.
Possible Side Effects
● Skin irritation (redness, dryness, itchiness)
● Stinging
● Burning
● Elevated calcium levels (if you’re using more than 100g per week)
RETINOIDS
(Adapalene, Tazarotene, Tretinoin)
Available by prescription
Retinoids (vitamin A derivatives) slow skin cell growth. They’re typically available as a gel, lotion, or cream. When you start using a topical retinoid, it’s normal for psoriasis plaques to become very red before clearing, but it shouldn't be painful.
Possible Side Effects
● Skin irritation (redness, swelling, peeling, blistering)
● Dry skin
● Increased susceptibility to sunburn. Apply it at night. It’s really important to use sunscreen and wear sun-protective clothing when using a topical retinoid!
CALCINEURIN INHIBITORS
(Pimecrolimus, Tacrolimus)
Available by prescription
Calcineurin inhibitors have been approved by the Food and Drug Administration (FDA) to treat eczema, not psoriasis. But many doctors also prescribe these ointments and creams to people with psoriasis. They reduce inflammation and plaque buildup and are suitable for plaque psoriasis on delicate areas (like the face and genitals) and inverse psoriasis.
Possible Side Effects
● Skin irritation (burning, itch, redness)
● Allergic skin reaction
SALICYLIC ACID
(Dermarest Psoriasis, DHS Sal, MG217 Sal-Acid, Neutrogena T/Sal)
Available OTC or by prescription
Salicylic acid shampoos and solutions are used to treat scalp psoriasis by softening and removing scales. Sometimes, salicylic acid products are used in combination with other medications, such as corticosteroids, to help them penetrate the skin. Dermatologists may prescribe this as a compounded prescription medication—that means a compounding pharmacy has to make it specifically for each individual patient.
Rinse thoroughly after use. Try not to get a salicylic acid product in your mouth, eyes, or nose, and don't use it if you have a rash or cut on the affected area.
Possible Side Effects
● Skin irritation (stinging), especially if left on skin too long
● Dry scalp
● Weakening of hair shafts, leading to breakage and temporary hair loss
COAL TAR
(Cutar Emulsion, MG217 Medicated Coal Tar Ointment, Neutrogena T/Gel)
Available OTC or by prescription
Coal tar has been used for more than 100 years to treat psoriasis. It slows skin cell growth and reduces scaling, itching, and inflammation. Generally, the higher the concentration of tar, the more potent the product. Different types are available, such as shampoo, cleansing bars, cream, and oil.
If reddening occurs, try applying the coal tar on top of a moisturizer.
Coal tar products can be messy and have a strong odor. They can stain clothing, bedding, and light-colored hair.
Possible Side Effects
● Skin irritation (stinging)
● Dry or red skin
● Increased risk of sunburn. Use sunscreen and wear sun-protective clothing when using a coal tar product!
SKINCARE TIPS
Wondering what else you can do to care for your psoriasis?
● Apply heavy creams and/or ointments every day to keep your skin moisturized. Stick to fragrance-free products to avoid irritation.
● Take lukewarm showers (not hot!) and limit them to 10 minutes or less.
● Add oil, oatmeal, Epsom salts or Dead Sea salts to a lukewarm bath and soak for 15 minutes. Don’t forget the moisturizer as soon as you get out.
● Some topical treatments can be covered to make them more effective. This is known as occlusion. After applying the treatment, cover the area with plastic wrap, cellophane, or a waterproof bandage. Always check with your doctor before occluding any treatments.
Let your doctor know if you’re pregnant, breastfeeding, or intend to become pregnant, as some topical treatments for psoriasis may not be recommended during this time.
SOURCES
American Academy of Dermatology, “Psoriasis Treatment: A Retinoid You Apply to the Skin.”
American Academy of Dermatology, “Psoriasis Treatment: Tacrolimus Ointment and Pimecrolimus Cream.”
British Association of Dermatologists, “Calcineurin Inhibitors.” 2016.
Grace K. Kim. (2010) The Rationale Behind Topical Vitamin D Analogs in the Treatment of Psoriasis. The Journal of Clinical and Aesthetic Dermatology.
National Psoriasis Foundation, “Non-Steroidal Topical Treatments.” 2020.
National Psoriasis Foundation, “Over-the-Counter Topicals.”
National Psoriasis Foundation, “Steroids.” 2020.](https://twill-happifiers-cms-uploads.happify.com/cms_uploads/en_US/img/crop_images/TwillCare-Topical-Treatments-for-Psoriasis_316b96b.png)
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