Dr. Alai is an actively practicing medical and surgical dermatologist in south Orange County, California. She has been a professor of dermatology and family medicine at the University of California, Irvine since 2000. She is U.S. board-certified in dermatology, a 10-year-certified fellow of the American Academy of Dermatology, and Fellow of the American Society of Mohs Surgery.
Dr. Cole is board certified in dermatology. He obtained his BA degree in bacteriology, his MA degree in microbiology, and his MD at the University of California, Los Angeles. He trained in dermatology at the University of Oregon, where he completed his residency.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
What creams or lotions are available for
psoriasis?
Topical (skin applied) medications include topical corticosteroids, vitamin D
analogue creams calcitriol, topical retinoids (Tazorac), moisturizers, topical
immunomodulators (tacrolimus and pimecrolimus), coal tar, anthralin, and others.
Topical corticosteroids (steroids, such as hydrocortisone) are very useful
and often the first-line treatment for limited or small areas of psoriasis. These
come in many preparations, including sprays, liquid, creams, gels, ointments, and
mousses. Steroids come in many different strengths, including stronger ones are
used for elbows, knees, and tougher skin areas and milder ones for areas like
the face, underarms, and groin. These are usually applied once or twice a day to
affected skin areas.
Strong steroid preparations should be limited in use. Overuse or prolonged
use may cause problems including potential permanent skin thinning and damage
called atrophy.
A vitamin D analogue cream called calcitriol has also been useful in psoriasis. The advantage of calcitriol is that it is not known to overly thin the skin like topical steroids. It is important to note that this drug is not regular vitamin D and is not the same as taking regular vitamin D or rubbing it on the skin.
A similar drug, calcipotriene, may be used in combination with topical steroids for better results. There is a newer two-in-one combination preparation of calcipotriene and a topical steroid called Taclonex. Results with calcipotriene alone may be slower and less than results achieved with typical topical steroids. Not all patients may respond to calcipotriene as well as to topical steroids.
A special precaution with vitamin D analogue creams is that it should not be used on more than 20% of the skin in one person. Overuse may cause absorption of the drug and an abnormal rise in body calcium levels.
Moisturizers, especially with therapeutic concentrations of salicylic acid,
lactic acid, urea, and glycolic acid may be helpful in psoriasis. These
moisturizers are available as prescription and nonprescription forms. These
help moisten and lessen the appearance of thickened psoriasis scales. Some
available preparations include Salex (salicylic acid), AmLactin (lactic acid),
or Lac-Hydrin (lactic acid) lotions. These may be used one to three times a day on the
body and do not generally have a risk of problematic skin thinning (atrophy).
Overuse or use on broken, inflamed skin may cause stinging, burning, and more
irritation. These stronger preparations should not be used over delicate skin
like eyelids, face, or genitals. Other bland moisturizers including Vaseline and
Crisco vegetable shortening may also be helpful in at least reducing the dry
appearance of psoriasis.
Immunomodulators (tacrolimus and pimecrolimus) have also been used with
some success in limited types of psoriasis. These have the advantage of not
causing skin thinning. They may have other potential side effects, including skin
infections and possible malignancies (cancers). The exact association of these immunomodulator creams and cancer is controversial.
Bath salts or bathing in high-salt-concentration waters like the Dead Sea
in the Middle East may help some psoriasis patients. Epsom salt soaks (available
over the counter) may also be helpful for a number of patients. Overall, these
are quite safe with very few possible side effects.
Coal tar is available in multiple preparations, including shampoos, bath
solutions, and creams. Coal tar may help reduce the appearance and decrease the
flakes in psoriasis. The odor, staining, and overall messiness with coal tar may
make it harder to use and less desirable than other therapies. A major advantage
with tar is lack of skin thinning.
Anthralin is available for topical use as a cream, ointment, or paste. The
stinging, possible irritation, and skin discoloration may make this less
acceptable to use. Anthralin may be applied for 10-30 minutes to psoriatic skin.
Cellulitis is an acute spreading bacterial infection below the surface of the skin characterized by redness, warmth, inflammation, and pain. The most common cause of cellulitis is the bacteria Staph (Staphylococcus aureus).
Anal itching is the irritation of the skin at the exit of the rectum, known as the anus, accompanied by the desire to scratch. Causes include everything from irritating foods we eat, to certain disease and infections. Treatment options include local anesthetics, vasoconstrictors, protectants, astringents, antiseptics, keratolytics, analgesics, and corticosteroids. If condition persists, a doctor examination may be needed to identify an underlying cause.
Itching can be a common problem. Itches can be localized or generalized. There are many causes of itching to include: infection (jock itch, vaginal itch), disease (hyperthyroidism, liver or kidney), reactions to drugs, and skin infestations (pubic or body lice). Treatment for itching varies depending on the cause of the itch.
Stress occurs when forces from the outside world impinge on the individual. Stress is a normal part of life. However, over-stress, can be harmful. There is now speculation, as well as some evidence, that points to the abnormal stress responses as being involved in causing various diseases or conditions.
Sacroiliac joint (SI) dysfunction is a general term to reflect pain in the SI joints. Causes of SI joint pain include osteoarthritis, abnormal walking pattern, and disorders that can cause SI joint inflammation including gout, rheumatoid arthritis, psoriasis, and ankylosing spondylitis. Treatment includes oral medications, cortisone injections, and surgery.
Arthritis is inflammation of one or more joints. When joints are inflamed they can develop stiffness, warmth, swelling, redness and pain. There are over 100 types of
arthritis including osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, lupus, gout,
and pseudogout.
Psoriatic arthritis is a disease that causes skin and joint inflammation. Symptoms include painful, stiff, and swollen joints, tendinitis, and organ inflammation. Treatment involves antiinflammatory medications and exercise.
Fungal nails (onychomycosis) may be caused by many species of fungi but the most common is Trichophyton rubrum. Distal subungal onychomycosis starts as a discolored area at the nail's corner and slowly spread toward the cuticle. In proximal subungal onychomycosis, the infection starts at the cuticle and spreads toward the nail tip. Yeast onychomycosis is caused by Candida and may be the most common cause of fungal fingernail.
Actinic keratoses are rough, scaly patches of skin that are considered precancerous and are due to sun exposure. Prevention is to cut sun exposure and wear sunscreen.
Dry skin (xeroderma) may be caused by external factors, like cold temperatures, low humidity, harsh soaps, and certain medications, or internal factors, such as thyroid disease, diabetes, psoriasis, or Sjogren's syndrome. Symptoms and signs of dry skin include itching and red, cracked or flaky skin. The main treatment for dry skin is frequent, daily lubrication of the skin.
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