Topical treatments for psoriasis

Topical treatments for psoriasis involve the use of creams and ointments for local application over the affected area of the skin. Topical treatment is usually the first line of treatment and is suitable for the mild form of psoriasis.

However, the use of bath solutions, moisturizers, mineral oil, and petroleum jelly as topical treatments will help soothe the psoriatic skin and reduce the skin dryness, which normally accompanies skin psoriasis.

The various topical treatments described below form the best choices. Some of them are natural remedies and are fairly effective in reducing the symptoms of skin, nail, and scalp psoriasis.

1. Bath Salts

Bath salts are quite safe and can be helpful in a number of cases. They are water-soluble, powdered minerals that are added to water and used for bathing.

They are commonly made from magnesium sulfate (Epsom salt) or sea salt and easily dissolve in warm bathwater.

The bath salts that are used imitate the characteristics of natural mineral baths or hot springs.

Well-defined red, thickened, and scaly skin patches that itch a lot characterize the skin of psoriasis. Soaking these skin areas in bath salts can help reduce the symptoms.

Bath salts not only nourish skin with minerals, but they also provide a stress-free mental setup.

During a psoriasis flare-up, the National Eczema Association recommends adding 1 cup of table salt to your bath to avoid stinging of the skin.

2. Moisturizers

Moisturizers are useful in reducing the itching, scaling, dryness, and cracking of the skin, which accompanies psoriasis. Moisturizers in an ointment base are more useful than those in a cream base.

These moisturizers, available over the counter and on prescription, should contain salicylic acid, lactic acid, glycolic acid, and urea in therapeutic concentration for better effect.

Brand names include Salex (salicylic acid), Amlactin, and Lac-Hydrin (both lactic acids). You can apply these moisturizers once or up to thrice a day for good effect. Avoid their use on eyelids, face, and genitals. Other moisturizers such as Vaseline or Crisco may help in reducing the dryness of the skin.

3. Salicylic acid preparations

Salicylic acid is classified as a keratolytic agent. It works by softening and separating the outer horny layer of skin causing it to shed. In psoriasis treatment, it helps to soften and remove psoriasis scales on the outer skin surface.

Available both as over the counter and on prescription, salicylic acid reduces the scaling of the skin and helps in the sloughing of dead skin cells. It is available in the form of medicated shampoos and scalp lotions for treating scalp psoriasis.

4. Topical corticosteroids

Topical steroid creams are recommended for mild to moderate forms of psoriasis. These are anti-inflammatory creams, which reduce the inflammation on the affected skin.

These creams slow down excessive cell turnover and reduce itching. Mild corticosteroid creams are recommended for skin covering the face, skin folds, underarms, and groin.

Stronger preparations are prescribed for more resistant and thickened forms of psoriasis and for skin covering the elbows and the knees. The application is recommended once or twice daily.

Overuse is cautioned as it can cause thinning of the skin and damage. Resistance too can develop. Psoriasis corticosteroid creams are, therefore, recommended only for active outbreaks.

If you are diabetic, exercise caution with the use of steroid topical applications.

5. Vitamin D Analogues | Calcipotriene

A Vitamin D analogue is a synthetic form of vitamin D and is not the same as that, which is given for oral use.

Calcipotriene (Donovex) is a prescription vitamin D cream. Other types of vitamin D analogues include calcipotriol, calcitriol and tacalcitol. These slow down the production of skin cells and reduce inflammation.

They are one of the most common types of topical treatments indicated in mild to moderate psoriasis and are often used along with phototherapy or other topical corticosteroid creams. Taclonex is one such preparation, which combines vitamin D and corticosteroids.

They are effective in certain cases and have the advantage that they do not cause skin thinning as corticosteroid creams do. Over usage can result in its absorption leading to increased calcium levels. It is, therefore, recommended not to use them over 20% of the skin.

6. Anthralin

Anthralin is a synthetic version of a natural substance found in goa powder, which comes from the araroba tree. It works by slowing down the growth of skin cells.

Anthralin or Dithranol reduces skin cell over-activity by normalizing the activity of the DNA in the skin cells. It works by slowing down the growth of skin cells and smoothens the skin by getting rid of the scales. It is available as a cream, ointment, or paste.

Anthralin has a slow mode of action in controlling psoriasis taking up to several weeks. This medication is, therefore, used in the treatment of long-term psoriasis such as chronic plaque psoriasis.

This product does not contain a corticosteroid or coal tar. It is not recommended for use in a severe flare-up when the skin is acutely inflamed and irritated.

Its disadvantage lies in the fact that besides skin irritation, it causes staining of the skin, clothes, and bed sheets, or anything it comes in contact with.

Anthralin is, therefore, recommended for use over open skin and for a short period of 10 to 30 minutes only. The treated area is covered with tube gauze and the surrounding skin is covered with soft white paraffin for protection.

7. Topical Retinoid

A retinoid is a synthetic form of vitamin A. There are different types and the one used topically to treat psoriasis is called tazarotene (Tazorac, Awage).

Topical retinoids are specifically indicated for treating mild to moderate plaque psoriasis. They are also used in the treatment of acne and sunburnt skin.

A retinoid acts by slowing down the overproduction of skin cells and reduces skin inflammation. It does this by normalizing the activity of the DNA of the skin cells.

Side effects include skin irritation and increased sensitivity to sunlight. Sunscreens are advised if you have to venture out into the sunlight after this has been applied.

Although the risk of congenital birth defects is minimal with these topical applications, their use during pregnancy and breastfeeding is not recommended. Similarly, its use in children is restricted.

8. Coal Tar

Coal tar is probably the oldest topical treatment being used for psoriasis. It is a thick black or brown oil obtained as a byproduct during the manufacture of petroleum products and coal.

It is available as coal tar topical solutions, which you can add to a bath, foams, shampoos, and ointments.  The advantages of using coal tar are:

  • Costs less than most other psoriasis treatments.
  • Is considered safe for long-term use.
  • Reduces itching and scales and also has anti-inflammatory action.

Its mechanism of action is not known.

Side effects are few but the biggest disadvantage is that it is messy, stains the clothes, and has a strong odor resembling that of naphthalene.

Over the counter, it is available as shampoos, ointments, soaps, and oil. Higher concentrations require a prescription. Brand names include Denorex and Psoriacin among others.

9. Calcineurin Inhibitors (CNI)

Calcineurin inhibitors (tacrolimus and pimecrolimus) are used in the treatment of atopic dermatitis. They have also been found to have some success in the treatment of certain types of psoriasis as oral and topical solutions.

They are classified as immunomodulating agents, which means that they act on the immune system to reduce psoriatic skin inflammation.

Their action is believed to be by disruption of T cells and consequently reducing the scales and inflammation. They should be used only if prescribed by your doctor.

Side effects include skin irritation. Their use does not cause thinning of the skin but long-term use has been associated with skin cancer and lymphoma.