Topical Psoriasis Treatments

Many new psoriasis treatment options have become available in recent years that have improved the quality of life for people with psoriasis. Here we look at some options for treating psoriasis with medication that can be applied to the skin -- known as topical medications. These include some old stand-bys and also some newer options.

Topical Corticosteroids

Topical corticosteroids are commonly prescribed for psoriasis. Topical steroids work by reducing inflammation and suppressing certain cells in the immune system.

They come in different strengths. Lower strength steroids may work better on the thin skin of the face, but it takes a much higher strength for elbows or knees. Therefore, it's always a good idea to label each medication tube with the body part it was prescribed for.

If used correctly, the risk of side effects is small. However, if not used correctly, serious and permanent side effects can occur such as:

• Acne and redness on the face
• Thinning of the skin
• Stretch marks
• Infections
• Glaucoma (if used around the eyes incorrectly)

Vitamin D Derivatives

Overactive white blood cells called T-cells can "attack" the skin and set off a cascade of events that make the skin cells multiply so fast they stack up on the surface of the skin. Vitamin D₃ calms down these T-cells. The following vitamin D derivatives are effective if applied alone, but are even more effective if applied with a topical corticosteroid:

• Vectical (calcitriol)
• Dovonex (calcipotriene)

Retinoids

Retinoids are vitamin A derivatives that are more commonly known for treating acne. Retin-A is the most well-known retinoid, but the only retinoid that is approved to treat psoriasis is Tazorac (tazarotene). It can irritate the skin easily, so there are different strategies to minimize this irritation including:

• Applying a topical steroid 12 hours after applying Tazorac
• Applying Tazorac and a topical steroid on alternating days
• Applying Tazorac for five minutes, then washing it off

Anthralin

Anthralin is an effective psoriasis treatment, but it does have several side effects. It is very irritating to the skin and can stain the skin. Newer treatment protocols call for using a higher strength formulation for a shorter period of time. Psoriasis plaques clear faster if anthralin if used in combination with UVB phototherapy.

Coal Tar

Coal tar has been used for years as a topical treatment for psoriasis, especially in shampoo-form. It can cause skin irritation and has an unpleasant smell. Coal tar should not be used by pregnant or breastfeeding women. While still used on occasion, coal tar treatments have become less common as newer medicines have been developed.

_Sources:

_{Habif, Thomas. ìPsoriasis and other Papulosquamous Diseases.î Clinical Dermatology, 4th Ed. Philadelphia: Mosby, 2004. 209-66.}

_{Levine, D, and A Gottlieb. ìEvaluation and management of psoriasis: an internist's guide.î Medical Clinics of North America. 93(2009): 1291-303.}

_{Menter, A, and CE Griffiths. ìCurrent and future management of psoriasis.î Lancet. 370(2007): 272-84.}

_{Mrowietz, U, and K Reich. ìPsoriasis--new insights into pathogenesis and treatment.î Dtsch Arztebl Int. 106(2009): 11-8, quiz 19.}

_{van de Kerhof, PCM and Joost Schalkwijk. "Psoriasis." Dermatology, 2nd Ed. Eds. Jean Bolognia, and et. al. Mosby, 2008. 115-35.}