Although there is currently no cure for psoriasis, treatments can help manage the condition.
Psoriasis creams may be the first line of treatment for many people. If people have mild psoriasis, they may be able to treat it with over-the-counter (OTC) creams.
In this article, we look at the types of topical treatments available, as well as other treatment methods for psoriasis.
According to a 2017 article, emollients are first-line treatment for psoriasis. Common examples of emollients include petroleum jelly and liquid paraffin.
Emollients can:
- moisturize dry skin
- relieve itching
- reduce scaling
- soften cracks
- form a protective film on the skin
A person can purchase emollients in many different forms. However, creams and ointments are preferable to lotions because they are thicker and, therefore, more effective.
Depending on the product, emollients may cause some side effects, such as:
- irritant dermatitis
- allergic contact dermatitis
- cosmetic acne
- stinging
- fragrance allergy
To reduce the chance of side effects, a person can opt for a fragrance-free product.
Emollients are safe to use during pregnancy and lactation.
How to use
People with psoriasis should use emollients liberally and frequently to help prevent their skin from drying out.
A person may wish to apply an emollient in the form of an ointment at night. They can use lighter forms, such as creams or lotions, during the day.
The American Academy of Dermatology Association (AAD) recommends using a heavy cream moisturizer once a day, or more frequently if the skin is very dry. It also recommends applying moisturizer to the hands within 3 minutes of washing them.
The United Kingdom’s National Health Service (NHS) notes that emollients may help to improve the efficacy of other topical ointments. A person should wait for at least 30 minutes after using an emollient cream before applying another topical ointment.
People may find a mild corticosteroid, such as hydrocortisone, is effective in treating small areas of psoriasis. An OTC corticosteroid can help reduce inflammation, which can slow the production of skin cells and reduce itching.
If a person’s skin is moist or weeping, they may prefer to use a cream. An ointment may be better suited for dry or flaky areas of skin. A lotion may be preferable for larger areas of skin.
Mild corticosteroid creams are safe, and a person should not experience side effects if they use them for less than 4 weeks. However, a person may notice a burning or stinging sensation when they apply the cream. This should subside after a few minutes.
How to use
A person should follow the instructions of a pharmacist, healthcare professional, or the leaflet that comes with the cream.
Typically, a person applies mild corticosteroid creams once or twice a day. The NHS states that a person should try to leave a gap of 8-12 hours between each application.
A person can perform the following steps when applying a mild corticosteroid:
- Wash and dry the hands.
- Spread the cream or ointment into a thin layer over the affected area of skin.
- Smooth it into the skin in the direction of the hairs until the cream disappears.
A person should take care to use the cream on all of the irritated areas of skin, and not just the worst areas. People should also take care to avoid putting the cream directly on broken skin or cuts.
Products containing salicylic acid help soften and remove psoriasis scales, as well as reduce any swelling. Salicylic acid may be effective in treating scalp psoriasis, as well as psoriasis plaques on the body.
Because salicylic acid helps remove thick, scaly skin, it can help other topical treatments penetrate the skin more easily, which may increase their effectiveness.
People need to follow instructions carefully for any products containing salicylic acid. Using excess amounts of salicylic acid may cause psoriasis to worsen, and could cause dry and itchy skin. People should also avoid using salicylic acid on open and cracked skin.
A person who is pregnant can use salicylic acid products for localized psoriasis. However, it may be unsafe to use on children.
How to use
People may find that scale softening products are most effective when people apply them after a 15-minute warm, but not hot, bath.
A person should avoid applying products containing salicylic acid before going for a phototherapy treatment session, as it can make the phototherapy less effective.
Coal tar is a thick and heavy oil. A person may find coal tar in ointments, creams, bath solutions, and OTC shampoos.
Coal tar is an active ingredient that may help with:
- reducing itchiness and flaking
- reducing any swelling or scaling
- slowing down the rapid growth of skin cells
Although safe, side effects can include:
- skin irritation
- rash
- acne-like breakout
- dry and brittle hair if using to treat scalp psoriasis
- a sensitivity to ultraviolet light
In some cases, it can even worsen psoriasis.
Those who are pregnant may wish to discuss alternative treatment options. There is little information about how safe coal tar is for those who are nursing.
How to use
People can try a small patch test before applying coal tar to a larger area of the body, and should follow all product instructions carefully.
A person using it in the form of a shampoo should massage the coal tar into the scalp. In some cases, a person can apply coal tar to the skin. A dermatologist should advise on how often to do this.
The AAD warns people to never apply coal tar to the rectum or genitals unless a dermatologist recommends it.
Psoriasis can cause itchy skin, which may not resolve until treatment for psoriasis is effective. While people are undergoing treatment for psoriasis, they may find using an anti-itch cream can help relieve symptoms.
People can look for a product containing the following ingredients:
- calamine
- camphor
- menthol
- hydrocortisone, which is a mild corticosteroid
Anti-itch creams may cause irritation or dryness of the skin. To counter this, people can look for a product that is also moisturizing, or use an anti-itch product alongside a soothing moisturizer.
If psoriasis does not respond to OTC treatments, people have larger patches of psoriasis, or have severe symptoms, they may need a prescription cream.
When using the following topical creams for psoriasis, a person should follow their healthcare professional’s instructions:
Stronger corticosteroids
Prescription corticosteroids may help to reduce swelling and scaling of psoriasis, slow down skin cell growth, and help clear psoriasis.
Side effects of corticosteroids can include:
- thinning of the skin
- spider veins
- stretch marks
- acne-like breakouts
It is important that people follow instructions from a healthcare provider when using prescription corticosteroids to reduce the risk of any side effects.
Vitamin D analogues
A dermatologist may recommend vitamin D analogues to use alongside, or instead of, steroid creams. Examples include tacalcitol, calcitriol, and calcipotriene. Calcipotriene is called calcipotriol in Europe.
According to the National Psoriasis Foundation, calcipotriene is a synthetic type of vitamin D3 that helps slow down the growth of skin cells, flatten psoriasis lesions, and remove scales. It is also suitable for treating psoriasis of the scalp and nails.
The most common side effects of calcipotriene include irritation of the skin, with stinging and burning sensations.
Calcitriol is a naturally occurring type of vitamin D3, and helps control excessive production of skin cells. Calcitriol is suitable for treating psoriasis on most areas of the body, apart from the face.
The most common side effects of calcitriol include:
- itching
- skin discomfort
- excessive amounts of calcium in urine
Retinoids
Prescription retinoids are vitamin A derivatives. They increase cell turnover time, which helps reduce the scaling that occurs as a result of psoriasis.
Tazarotene can cause skin irritation and dryness, and increase the risk of sunburn. It is important to protect the skin from the sun when using tazarotene. This includes wearing sunscreen and protective clothing.
People can contact a healthcare professional if they experience any uncomfortable symptoms, such as burning, stinging, or itching. Tazarotene is not suitable for anyone who is pregnant.
Anthralin
Anthralin is a medication that slows down rapidly growing skin cells. It is suitable for treating stable psoriasis of the scalp in people over the age of 12.
People will need to apply the medication wearing plastic gloves, as anthralin can discolour the fingernails.
People will also need to wash their hands straight afterward, first with lukewarm water and then with soap and warm water.
A healthcare professional may recommend rotating topical treatments to reduce irritation of the skin.
There is a range of psoriasis treatments that people may use alongside or instead of topical creams. These include phototherapy, which involves exposing the skin to certain lights. Other options are oral medications and biologics.
Biologics target specific parts of the immune system and block the action of the cells that play a major role in the development of psoriasis. A healthcare professional will administer biologics in the form of an injection or intravenously.
A person can also help relieve symptoms using home remedies such as:
- reducing stress, if possible
- eating a balanced diet
- avoiding smoking and alcohol
There is a wide range of treatment options for psoriasis. People may be able to treat mild or smaller patches of psoriasis with OTC topical creams. For more severe or larger areas of psoriasis, people may require prescription-strength creams.
If topical treatments are not effective, people may consider other treatment options such as phototherapy, oral medication, and injectable biologics.
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