Topical Agents

Corticosteroids

Clobetasol (Temovate), triamcinolone (Aristocort), fluocinolone (Synalar), and betamethasone (Diprolene) are some commonly prescribed corticosteroids.

• How corticosteroids work: Corticosteroids decrease skin inflammation and itching.



• Who should not use these medications: Individuals with corticosteroid allergy or skin infections should not use corticosteroids.



• Use: Apply a thin film to affected skin areas. These creams or ointments are usually applied 2 times a day, but dosage depends on severity of the psoriasis.



• Drug or food interactions: No interactions have been reported with topical use.



• Adverse effects: Corticosteroids may cause adverse effects to the body if used over large areas or on raw skin areas. They can also cause local thinning of the skin. Do not use for long periods of time. It is best not to put bandages over the treated skin unless directed by the physician because too much of the medicine may be absorbed into the body.

Calcipotriene (Dovonex) is a relative of vitamin D-3 that is used to treat moderate psoriasis.

• How vitamin D medications work: Calcipotriene slows the production of excess skin cells.



• Who should not use these medications: Individuals with the following conditions should not take calcipotriene:
  
  
  • Allergy to calcipotriene cream
  
  
  
  • Elevated calcium levels in the blood
  
  
  
  • Vitamin D toxicity


• Use: Apply to affected skin area 2 times a day. This medication is available as a cream, ointment, or solution.



• Drug or food interactions: Topical salicylic acid inactivates calcipotriene. Do not use creams or ointments containing these medicines at the same time.



• Adverse effects: Do not use this medicine on the face, around the eyes, or inside the nose or mouth. Do not use more than 100 grams per week (1 large tube of cream or ointment). This agent may cause skin irritation and is impractical and expensive for widespread application.

• Coal tar (DHS Tar, Doak Tar, Theraplex T) 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. Sometimes coal tar is combined with UV-B light therapy.



• How coal tar works: The tar decreases itching and slows the production of excess skin cells.



• Who should not use these medications: Individuals with the following conditions should not use tar-containing preparations:
  
  
  • Tar allergy
  
  
  
  • Recent severe inflammation
  
  
  
  • Patches of psoriasis that are bleeding or oozing


• Use: Apply coal tar preparations daily for severe psoriasis. Apply 2 times per week for mild psoriasis. Rub the medicine on the skin or scalp and rinse thoroughly. Repeat, leave on for 5 minutes, and then rinse thoroughly.



• Drug or food interactions: No interactions have been reported.



• Adverse effects: Avoid contact with eyes, inside the nose or mouth, or open wounds. Stop using if the skin becomes more irritated or if symptoms are not reduced. Coal tar tends to stain clothing and linens and can have a strong odor. This medicine may cause the skin to be more sensitive to the sun than normal. Coal tar may also cause inflammation of hair follicles.

Anthralin (Dithranol, Anthra-Derm, Drithocreme) is a synthetic form of a tree bark extract that is considered to be one of the most effective antipsoriatic agents available. However, it can cause skin irritation and staining of clothing and skin.

• How tree bark extract works: This medicine slows the production of excess skin cells.



• Who should not use these medications: Individuals with anthralin allergy or recent or excessively swollen patches should not use anthralin.



• Use: Apply a small amount of the cream, ointment, or paste to the patches on the skin.  On the scalp, remove scales and rub into affected areas. Avoid the forehead, eyes, and any skin that does not have patches. Do not apply excessive quantities. Short applications of a high concentration for only 20 minutes, followed by washing with soap and water can be used to minimize skin irritation.



• Drug or food interactions: Anthralin is combined with salicylic acid in preparations used for psoriasis treatment.



• Adverse effects:  Anthralin stains clothing or linens purple or brown. Use with caution if the individual has kidney disease. Care must be taken to apply this medication only to psoriasis patches and not to surrounding normal skin. Anthralin may cause skin discoloration (increased pigment) and may burn or irritate skin. Do not use on the face, neck, skin folds (back of knees or elbows), or genitals. Avoid contact with the eyes. Do not use on excessively irritated patches. This medication should only be used if the patient can comply with instructions for use.

Tazarotene (Tazorac) is a topical retinoid that is available as a gel or cream. This medicine is sometimes combined with corticosteroids to decrease skin irritation when used alone and to increase effectiveness. Tazarotene is particularly useful for psoriasis of the scalp.

• How topical retinoids work: They reduce the size of psoriasis patches and the redness of the skin.



• Who should not use these medications: Individuals with the following conditions should not use topical retinoids:
  
  
  • Allergy to retinoids
  
  
  
  • Pregnancy (Note: A pregnant woman should NOT use or take a retinoid medicine.)
  
  
  
  • Breastfeeding


• Use: 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.



• Drug or food interactions: Cosmetics or soap products that dry or irritate the skin may worsen the irritation and dry skin when used with a topical retinoid.



• Adverse effects: Do not use this medicine on the face, around the eyes, or inside the nose or mouth. Do not use on open wounds or sunburned skin. This medicine may cause burning or stinging. Sensitivity to the sun may occur. If skin irritation or pain increase, contact a doctor.