What Are My Options For Topical Treatments?

Fortunately, many different topical treatments are available to treat psoriasis. Your initial choices may depend on recommendations from your doctor, and different therapies are usually used over time.

Topical Steroids

Topical steroids are the mainstay and first choice for mild psoriasis treatment. For most patients, this is the first treatment they will try. Among topical steroids, various types, strengths, brands, and vehicles (the cream, lotion, or ointment that the steroid is mixed into) are available. They are easy and convenient to use and are great for short-term use. Unfortunately, they may lose some effect over time and can cause skin thinning at high doses. It might be helpful to take a break from steroids and use a different treatment for a few weeks in order to improve their effectiveness.

Calcipotriene, Sold as Dovonex and Calcitriol, Sold as Vectical

Calcipotriene and calcitriol are vitamin D analogs approved by the Food and Drug Administration (FDA) to treat psoriasis. Calcipotriene is currently available in three formulas—a cream, an ointment, and a solution—all at the same concentration (0.005%). The side effects are generally mild and include stinging skin. It is not recommended for use on the face, near the eyes, or on mucous membranes. For people using calcipotriene on a large body surface area, blood calcium levels may increase. Neither medication has been formally evaluated for use in children. There is also a combination product containing calcipotriene and the steroid betamethasone that is sold as the product Taclonex in the United States and as Daivobet in Europe. Its major advantage is that it is approved for once-daily use and may therefore be much easier for some people to use than the component ingredients applied separately up to two times a day.

Tazarotene, Sold as Tazorac

Tazarotene is a derivative of vitamin A available by prescription as a gel and a cream at two strengths (0.05 and 0.1%) and is approved by the FDA to treat psoriasis, acne, and photoaging (aging caused by the sun). It is effective by itself and in combination with topical steroids, light, or calcipotriene. The most common side effect of topical tazarotene is stinging and skin irritation. This irritation may improve with time, but you might need to use the lower strength, use it with a topical steroid, or stop using it for a period of time. Women of childbearing age are strictly advised not to get pregnant while using this medication because it can absorb into the system; a physician may require a pregnancy test before use.

Tar and Its Derivatives

Ta r and its derivatives (crude coal tar, anthralin, and liquor carbonis detergens [LCD]) are some of the oldest treatments for psoriasis and continue to be effective and inexpensive. Tar is commonly found in over-the-counter tar shampoos, including Neutrogena T-Gel, some of which are marketed to treat dandruff. There are several commercial tar-based solutions (Psorent), creams, ointments, foams (Scytera), and gels on the market as well, most sold without a prescription. Alternatively, physicians can write a prescription for LCD (in some places a prescription is not required), a form of tar that can be easily mixed at home into a petrolatum-based ointment (such as Vaseline) and is a very inexpensive treatment approach.

For psoriasis, anthralin is currently sold over-the-counter in a 1% cream as Psoriatec and in other products for topical use. Because it can be irritating, it is often used for short periods and then washed off. Two common regimens are applying it for 10 to 30 minutes before washing off and overnight use of a cream or ointment preparation that is washed off in the morning. Unless the hands are also being treated, they should be washed immediately after touching tar or anthralin. Anthralin should not be applied to skin folds or broken skin. It can stain clothing, towels, bed sheets, and the shower—everything that comes into contact with anthralin needs to be washed immediately, including shower tiles, to prevent brown staining.