There are Many Topical Options for Treating Psoriasis
- Psoriasis is an auto-immune disease that can cause itchy, red patches to develop on the skin. It is a chronic illness.
- There are several treatment options available, including many topical creams and ointments that can help alleviate symptoms.
- Since psoriasis is a chronic condition, ointments with steroids may be helpful, but they cannot be part of a long-term plan.
- Treatment may be a combination of several different approaches, such as topical treatments plus lifestyle adjustments.
Topical treatments are considered a mainstay for psoriasis, according to Dr. Saakshi Khattri, a dermatologist/rheumatologist at Mount Sinai Health System.Read More
“The majority of patients with psoriasis overall are managed with topicals only,” Dr. Han explains. “And I would say part of this is from convenience, and you could argue certainly patients with milder forms of psoriasis, it’s justifiable to just treat topically.”
According to the American Academy of Dermatology (AAD) and the National Psoriasis Foundation (NPF) guidelines, topical medications are used to treat patients with mild to moderate psoriasis. Topicals are also frequently used as additional treatment for patients on phototherapy, systemic, or biologic therapy.
Topical Treatment Options for Psoriasis
Psoriasis treatments aim to stop skin cells from growing so quickly (the disease causes the skin to regenerate faster than normal, leading to scales and red patches). There are several treatment options, and the route you go with will depend on what type of psoriasis you have and how symptoms are presenting.
Several different topical ointments for psoriasis and creams may be prescribed, including the following:
Corticosteroids: These drugs may be prescribed to treat mild to moderate psoriasis and can be a good option during flare-ups. They are available as ointments, creams, lotions, gels, foams, sprays, and shampoos. Normally, they are effective in reducing inflammation and relieving itching. But when used too much they can lead to thinning of the skin.
Topical corticosteroids are classified into seven categories based on their potency, ranging in strength from ultra-high to low. Lower potency corticosteroids are typically used on the face, while areas with thick, chronic plaques often require treatment with ultrahigh-potency corticosteroids. An example of a mild corticosteroid is Hydrocortisone.
Vitamin D analogues: These synthetic forms of vitamin D can help slow skin growth. The drugs can be used alone or in combination with corticosteroids. Calcipotriene (also known as calcipotriol) and calcitriol are the two commonly used synthetic vitamin D analogues. They have anti-inflammatory effects and reduce skin cell production. When used in moderation, they don’t pose any side effects.
A recent study published in the Journal of Clinical, Cosmetic, and Investigational Dermatology in 2020, acknowledged that “Calcipotriol/betamethasone dipropionate foam is the only topical formulation that will present long-term data as a twice-weekly proactive treatment approach up to 52 weeks for chronic plaque psoriasis.”
Retinoids: Retinoids can come as a gel or cream and be used to relieve some psoriasis symptoms. Topical tazarotene (Tazorac) can be particularly helpful for palmar-plantar psoriasis (palms and soles) and nail psoriasis, the AAD and NPF guidelines say. They are made of vitamin A and work by speeding up the growing and shedding of skin.
However, women who are pregnant or planning to be pregnant should completely avoid using retinoids due to their association with birth defects.
Calcineurin inhibitors: These drugs reduce inflammation and plaque buildup. These may be helpful in areas where the skin is thin, like around the eyes, but should not be used for long periods due to potential side effects.
Side effects of calcineurin inhibitors include allergic skin reactions, itching, and burning.
Although not yet FDA-approved for psoriasis, topical calcineurin inhibitors tacrolimus and pimecrolimus are often used in the treatment of psoriasis. However, the FDA warns of the possibility that patients who use calcineurin inhibitors may be at a higher risk of developing skin cancer or lymphoma (cancer of the lymph nodes). This possibility was built on previous data provided from animal studies. Thus, further investigation of its long-term safety is warranted.
Salicylic acid: These shampoos and scalp solutions can reduce the symptoms of psoriasis on the scalp. Salicylic acid minimizes scaling and softens plaques. It can also be combined with other topical medications including corticosteroids.
Coal tar: A product of coal, this medication has been used to treat psoriasis for more than a century, according to AAD and NPF. These drugs can reduce scaling, itching, and inflammation as well as slow the rate by which cells reproduce and grow.
They are found in shampoos, creams, bath solutions, and oils for psoriasis. Since they can irritate your skin, doctors recommend testing coal tar on a limited area before using it all the way. Additionally, they can stain and have a very strong odor.
Moisturizers. This is not a specific treatment for psoriasis, but it can be very effective in treating dryness caused by the disease and promoting healing of the skin. The best moisturizer to buy will have the following characteristics:
- Heavy textures like oils, ointments, or creams
- Doesn’t include any fragrance to avoid irritation
Doctors do have to be careful when prescribing ointments or lotions, however, because psoriasis is a chronic condition. Some products may be good for specific outbreaks but may not work in the long term due to potential side effects.
“When you’re looking at topical medications, steroids or topical steroids are really the mainstays for treating psoriasis,” Dr. Khattri explains. “However, we can’t use them chronically because of side effects, so as a steroid-sparing option, we have a few things to choose from.”
While the treatment approach to psoriasis can vary a great deal from person to person, many people with the disease have found that certain things in their environments can trigger psoriasis outbreaks.
Triggers associated with psoriasis outbreaks include:
- Infections, such as strep throat or skin infections
- Weather, particularly cold, dry conditions
- Injury to the skin, such as cuts, scrapes, a bug bite, or burn
- Smoking or exposure to smoke
- Heavy alcohol consumption
- Certain medications, such as lithium and high blood pressure drugs
Psoriasis treatment might be a combination of topical treatments or topical treatments mixed with other methods. Lifestyle adjustments may also be part of your treatment plan. The treatment plan you and your doctor decided to take will depend on several factors, so it’s important to voice your own concerns about the disease to your doctor when discussing your health.
“If you have psoriasis on your skin and if it’s affecting your quality of life, it’s important to advocate for yourself and not be dismissed by a healthcare practitioner,” Dr. Khattri says. “And if you feel that wherever you have psoriasis is really affecting you, just ask for options to treat your psoriasis. If a specific topical treatment is not adequate, ask for something systemic; ask for.”
Dr. Han agrees: “If it’s not working for you, you should definitely ask about other treatments because we have a lot out there. A lot of them are very safe and well-studied, and people shouldn’t just be complacent and accept something that isn’t working for them.”
Questions to Ask Your Doctor
- Is a topical ointment the best treatment option for my condition?
- How severe is my psoriasis?
- Should I combine topical treatment with another method?
- Is there anything I should do to improve my treatment response?
- Are there any specific triggers I should avoid?
- What is the next step if the topical treatment doesn’t work?
The Bottom Line
Psoriasis is an auto-immune disease that can cause itchy, red patches to develop on the skin. It is a chronic illness. There are several treatment options available, including many topical creams and ointments that can help alleviate symptoms. It’s crucial to note that even though topical medications can help with psoriasis, it remains a chronic condition. So, they cannot be part of a long-term plan.
Alternatively, your doctor may recommend a new treatment strategy like pairing up several different approaches, such as topical treatments plus lifestyle adjustments, or combining topical with systemic treatments — this will ultimately depend on your condition.