Psoriasis (cont.)
What creams or lotions are available?
Topical (skin applied) medications include topical corticosteroids, vitamin D
analogue creams (Dovonex), 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 calcipotriene (Dovonex) has also been
useful in psoriasis. The advantage of calcipotriene 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.
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 calcipotriene 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.
Next: What oral medications are available? »
- coal tar shampoo-topical, Denorex, Neutrogena T/Gel, Pentrax, Tegrin, Zetar - Consumer information about the medication COAL TAR SHAMPOO - TOPICAL (Denorex, Neutrogena T/Gel, Pentrax, Tegrin, Zetar), includes side effects, drug interactions, recommended dosages, and storage information. Read more about the prescription drug COAL TAR SHAMPOO - TOPICAL.
- Photodynamic Therapy - Read about photodynamic therapy (PDT). PDT uses a photosensitizing agent and light source to treat cancers (skin, lung, esophageal, Barrett's esophagus), acne and rosacea.
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