Psoriasis – Topical Treatments

Topical treatments for Psoriasis are the most commonly used and the safest of the treatment modalities for Psoriasis and I prescribe them to my patients on a daily basis in both my The Woodlands dermatology and Conroe dermatology offices.  Topical medicines come in many different forms which include creams, ointments, solutions, gels, sprays and shampoos.  Topical corticosteroids are the most commonly prescribed medicines for Psoriasis.  They function to reduce inflammation in the Psoriatic plaque and to slow the growth cycle of the affected skin.  Topical corticosteroids range in varying strengths which must be appropriately selected for different anatomic areas.  Typically, they are applied twice a day only to the Psoriatic plaque with special attention not to place on normal skin.  Once the Psoriatic plaque has resolved, the use of topical corticosteroids is discontinued.  Vitamin D analogs such as calcioptriene are also very helpful in a topical treatment regimen.  The drawback to calcipotriene is that it is irritating to the skin, so it is usually only applied daily.  Calcipotriene and topical corticosteroids cannot be mixed together and maintain their efficacy due to differences in pH.  However, Taclonex is a new formulation that has been able to combine betamethasone, a very potent topical steroid, with calcipotriene.  Taclonex only needs to be used daily, but its drawback is that it is very expensive.  Salicylic acid is a topical that is effective at dissolving the white scale overlying the Psoriatic plaques.  Thus, other topical treatments can penetrate the plaques more efficiently.  Topical retinoids such as Tazorac have also been used to regulate the growth cycle of the Psoriatic plaque, unfortunately they can be irritating to the skin.  Coal tar has been successful in treating Psoriatic plaques, but it has a pungent odor and has carcinogenic capabilities.