1. Moderate to Severe Psoriasis Slideshow Pictures
2. Psoriasis Quiz: Test Your Medical IQ
3. How Much Is Psoriasis Affecting Your Life?

Medical Author:

Gary W. Cole, MD, FAAD

Gary W. Cole, MD, FAAD

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.

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Medical Editor:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

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.

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In this Article

• Psoriasis facts
• What is psoriasis?
• What causes psoriasis?
• What does psoriasis look like? What are psoriasis symptoms and signs?
• Can psoriasis affect my joints?
• How is psoriasis diagnosed?
• Can psoriasis affect only my nails?
• How many people have psoriasis?
• Is psoriasis curable?
• Is psoriasis contagious?
• Can I transmit the gene for psoriasis to my children?
• What kind of doctor treats psoriasis?
• What is the treatment for psoriasis?
• What creams, lotions, and home remedies are available for psoriasis?
• What oral medications are available for psoriasis?
• What injections or infusions are available for psoriasis?
• What about light therapy for psoriasis?
• Where can I get more information on psoriasis?
• Is there a national psoriasis support group?
• What is my long-term prognosis with psoriasis? What are complications of psoriasis?
• Pictures of Psoriasis - Slideshow
• Take the Psoriasis Quiz
• Psoriasis FAQs
• Patient Comments: Psoriasis - Symptoms
• Patient Comments: Scalp Psoriasis - Treatment
• Patient Comments: Psoriasis - Effective Treatments
• Find a local Dermatologist in your town
• Psoriasis Index

Topical (skin applied) medications include topical corticosteroids, vitamin D analogue creams like 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 foams. Steroids come in many different strengths, including stronger ones that 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.



• Calcitriol cream is useful in psoriasis because of its effect on calcium metabolism. The advantage of calcitriol is that it is not known to thin the skin like topical steroids.
  
  A similar drug, calcipotriene, may be used in combination with topical steroids for better results. There is a newer combination preparation of calcipotriene and a topical steroid called Taclonex. Not all patients may respond to calcipotriene. Prolonged use of these types of medications on more than 20% of the skin surface can produce a 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 scales that impede the movement of topical medications into the deeper layers of the skin. 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. 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.