Topical Medications for Psoriasis
Medications applied directly to the skin are the first course of treatment options. The main topical treatments are corticosteroids, vitamin D3 derivatives, coal tar, anthralin, or retinoids. For more detailed information on each medication, see Understanding Psoriasis Medications. Generic drug names are listed below with examples of brands in parentheses.
- Corticosteroids: Topical corticosteroids are the mainstay of treatment in mild or limited psoriasis and come in a variety of forms. Foams and solutions are best for scalp psoriasis and other thickly hair-bearing areas, such as a hairy chest or hairy back. Creams are usually preferred by patients, but ointments are more potent than any other vehicles, even at the same percentage concentration. Super potent topical corticosteroids such as clobetasol propionate (Temovate) and betamethasone diproprionate (Diprolene) are commonly prescribed corticosteroids for use on non-facial, non-intertriginous areas (areas where skin surfaces do not rub together). As the condition improves, one may be able to use potent steroids such as mometasone furoate (Elocon) or halcinonide (Halog) or mid-potency steroids such as triamcinolone acetonide (Aristocort, Kenalog) or betamethasone valerate (Luxiq). These creams or ointments are usually applied once or twice a day, but the dose depends on the severity of the psoriasis as well as the location and thickness of the plaque. While it is best to use stronger, superpotent corticosteroids on thicker plaques, one should usually use milder steroids in skin folds (inverse psoriasis) and on the genitals. In skin folds or facial areas, it is best to use milder topical steroids such as hydrocortisone, desonide (DesOwen), or alclometasone (Aclovate). The calcineurin inhibitors such as tacrolimus (Protopic) and pimecrolimus (Elidel) have less use in plaque type psoriasis than they do with eczema but are sometimes effective on the face or occluded areas. Commonly, patients who are using one or more of the systemic agents discussed below will still require some use of topical corticosteroids for resistant areas and "hot spots." Occasionally, when there is concern about the long-term use of a potent topical corticosteroid, pulse methods may be used with one of the vitamin D or A analogs discussed below. An example would be to use the nonsteroidal topical agent (or a milder corticosteroid) during the week and more potent steroid on the weekends.
Picture of genital psoriasis. Image courtesy of Jeffrey J. Meffert, MD. Picture of inverse psoriasis affecting the armpit. Image courtesy of Jeffrey J. Meffert, MD.
- Vitamin D: Calcipotriene (Dovonex) is a form of vitamin D3 and slows the production of excess skin cells. It is used in the treatment of moderate psoriasis. This cream, ointment, or solution is applied to the skin twice daily. Calcipotriene combined with the betamethasone dipropionate (Taclonex) flattens lesions, removes scale, and reduces inflammation and is available as an ointment and a solution. As is the case with many combination medications, it may be much less expensive to apply the individual components sequentially than a single application of a prepackaged mixture. Calcitriol ointment (Silkis, Vectical) contains calcitriol, which binds to the vitamin D receptors on skin cells and reduces the excessive production of skin cells, which helps to improve psoriasis. Calcitriol ointment should be applied to the affected areas of skin twice a day.
- Coal tar: Coal tar (DHS Tar, Doak Tar, Theraplex T, Zithranol) contains literally thousands of different substances that are extracted from the coal carbonization process. Coal tar is applied topically and is available as shampoo, bath oil, ointment, cream, gel, lotion, ointment, paste, and other types of preparations. The tar decreases itching and slows the production of excess skin cells and is especially useful when used with or combined with a topical corticosteroid. It is messy and has a strong smell.
- Corticosteroids: Clobetasol (Temovate), fluocinonide (Lidex), and betamethasone (Diprolene) are commonly prescribed corticosteroids. These creams or ointments are usually applied twice a day, but the dose depends on the severity of the psoriasis.
- Tree bark extract: Anthralin (Dithranol, Anthra-Derm, Drithocreme) is considered to be one of the most effective antipsoriatic agents available. It does have the potential to cause skin irritation and staining of clothing and skin. Apply the cream, ointment, or paste sparingly to the patches on the skin. On the scalp, rub into affected areas. Avoid the forehead, eyes, and any skin that does not have patches. Do not apply excessive quantities.
- Topical retinoid: Tazarotene (Tazorac) is a topical retinoid that is available as a gel or cream. Tazarotene reduces the size of the plaques and the redness of the skin. This medicine is sometimes combined with corticosteroids to decrease skin irritation and to increase effectiveness. Tazarotene is particularly useful for psoriasis of the scalp. Apply a thin film to the affected skin every day or as instructed. Dry skin before using this medicine. Irritation may occur when applied to damp skin. Wash hands after application. Do not cover with a bandage. Tretinoin (Retin-A), another retinoid drug, is more effective for acne than it is for psoriasis related problems.
- Keratolytics: A useful addition to topical steroids is to add a keratolytic medication to remove overlying scale so that the steroid can reach the affected skin sooner and more effectively. Salicylic acid shampoos are useful in the scalp, and urea (either prescription strength or over-the-counter lower strengths) may be used on body plaques.
Medically Reviewed by a Doctor on 11/30/2015
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