“Psoriasis is not curable, but thankfully it’s very treatable,” says Mona Gohara, MD, associate clinical professor of dermatology at the Yale School of Medicine. “There’s no need to endure the psychological or physical discomfort that may come along with this condition—seek treatment for it.” There are a range of possible treatments, from topical creams and lotions to prescription oral medications. “If you start at the bottom of therapeutic pyramid with creams, this may be enough to quell the irritation,” says Dr. Gohara.
Topical treatments for psoriasis:
Some creams and lotions that can ease the dryness and itch are available over the counter; with others, you’ll need a prescription from a doctor. It takes a bit of trial and error to find what topical treatment may work best for you. Here, some guidance to the most common types of creams and lotions for psoriasis.
Photo credit: Iryna Veklich - Getty Images
Salicylic acid
This is the active ingredient (approved by the FDA for treating psoriasis) in treatments that can help banish scales by softening them and making the outer layer of skin shed. You can find salicylic acid in many forms (not just lotions/creams/ointments, but also foams, soaps, gels, patches, and more). These treatments are designed to work in combo with others, because getting rid of the scales can help other treatments do their work more efficiently. If it’s a strong version, salicylic acid can irritate the skin and make hair more likely to break off, and that can lead to temporary hair loss, says the NPF.
Topical steroids (Corticosteroids)
The NPF says that these are the most frequently used treatments for psoriasis. They’re designed to quell inflammation and pump the brakes on the growth of skin cells (this helps sidestep the build-up that produces scales). Steroid treatments come in different strengths; mild ones are available over the counter (OTC) and stronger types require a prescription. Generally, the stronger ones are needed for elbows, knees, and other hard to treat areas. These are powerful meds with potential side effects (thin skin, broken blood vessels, and more) and should be used carefully under a medical doctor's supervision. Also, “the use of topical steroids on brown skin can create lightening, which may take time to repigment,” says Dr. Gohara. “It’s always important to apply steroids directly on, not all around, lesions or areas of concern.”
The NPF advises not to use a topical steroid for longer than three weeks without consulting a doctor, as well as to avoid stopping the use of one suddenly because that can cause a flare-up of your psoriasis. Another reason to use these under the care of a physician: Topical steroids can be absorbed via the skin and have an impact on internal organs when used for a long period of time or over a wide area of skin.
Vitamin D3 treatments
These prescription treatments also come in various forms — not just creams, lotions and ointments, but also gels, foams, and more. In some medications, vitamin D is combined with a steroid. Like other treatments, meds with vitamin D slow down the pace of your skin cells' growth. (Depending on the specific medication, side effects can include skin irritation, stinging, burning, itching or excessive calcium in the urine.) “One advantage of vitamin D creams is they don’t run the risk of causing skin atrophy — a very real side effect of chronic topical steroid use,” says Dr. Gohara. “But they can be more irritating. Generally, systemic side effects are rare, yet hypercalcemia is a theoretical risk, and your doctor may opt to have you get blood tests.”
Vitamin A treatments
A topical retinoid, vitamin A is the active ingredient in prescription medication that comes in the form of a cream, gel, or foam. It also works by slowing the growth of skin cells. When using it, the plaques of psoriasis may turn bright red before clearing up. Side effects here also include skin irritation; the medication increases the risk of sunburn as well, so it’s critical to use sunscreen to protect your skin when using these meds.
Coal tar
This ingredient is found in different strengths in various treatment forms, including shampoo. It can be found in OTC products in its weaker strength and by prescription for stronger versions. Like other products, coal tar slows the growth of skin cells, but it can be stinky and irritating, and can stain your bedding and clothes (as well as blond hair).
Finding the right psoriasis treatment:
Here’s one of the challenging things about treating psoriasis: Your body can build up a tolerance to a certain medications, so something that seemed magical in its ability to bring you relief could suddenly stop working. On the other hand, a treatment that didn’t work for you years ago could suddenly work wonders.
That’s why trial and error is a necessary part of psoriasis treatment. “Finding the right treatment for psoriasis is much like finding the right partner. It may take some 'dating' until the right one finally comes along,” says Dr. Gohara. “Some may work for a bit, but then efficacy fizzles. Topical steroids are the most common culprit of this phenomenon, although it may happen with other topical or systemic medication as well.”
The best over-the-counter creams that can ease the dryness and itching:
According to the National Psoriasis Foundation, it’s key to moisturize daily — it can lessen the itchy redness. They recommend that you use fragrance-free products and soaps that moisturize rather than dry you out, skip the way-hot shower (keep it lukewarm), and rub on moisturizer right after showering. The NPF recommends these OTC creams, based on information they’ve heard from dermatologists — while emphasizing that none of them are stand-ins for treatment from a healthcare provider. Still, they’re all deeply moisturizing and may improve some pesky symptoms such as flaking and itching.
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