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.
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
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.
Reviewed by William C. Shiel Jr., MD, FACP, FACR on 5/16/2013