Topical Psoriasis Medications

1. Over the counter topical medications, your first line of treatment for mild Psoriasis.
2. FDA approved ingredients and Natural ingredients in OTC medications.
3. Information on the Goeckerman Regime
   
4. Reference resource for further information on prescription treatments for more severe Psoriasis.

An in-depth look at topical Psoriasis medications available over the counter, how they work, their effectiveness and resources for advice on stronger, prescription treatments.

As you can see from the treatment ladder image (below), topical medications are the first line of treatment for anyone suffering with psoriasis.

Psoriasis can be very difficult to treat effectively and is complicated by the fact that one treatment may work well for some time and then suddenly stop being effective.

On the other hand, a medication tried in the past which has been ineffective, may work very well when tried again.

Of course the type of treatment applied to the skin will depend on the severity of your psoriasis and what suits you best. There are creams, lotions, gels, shampoos, sprays, solutions and occlusive tapes to cover affected skin areas.

Many of these products are available over the counter (OTC), without a prescription and it is these that we will be looking at in depth in this article. OTC medications are the least potent and therefore have fewer potential side effects and are intended for those mildly affected by this skin condition.

More potent medications are available on prescription and in this short article, it is not possible to cover all these in depth but there is excellent and comprehensive information available if you know where to look - so please scroll down to the end of the article where I have put together a resource for you. There you will find reference sources that should answer all your questions whether you have been prescribed a topical treatment that you want to find out more about or whether you are searching for a solution to your own psoriasis problem.

The FDA has approved two ingredients for the treatment of psoriasis in these over the counter treatments, they are salicylic acid which is also used as a treatment for acne and coal or wood tar.

Salicylic Acid

Salicylic acid peels the topmost layer of the skin, removing psoriasis “scales” or “plaques”. As mentioned, this product is used for acne and other skin conditions too so it is a very commonly used substance and one that has been proven to be safe and with few associated problems when used as directed.

Salicylic acid is an active ingredient in many topical psoriasis medications, not only creams and lotions, but also in soaps and shampoo. In over the counter medications the concentration of this ingredient is 3% or less. There are products with greater concentrations but these are only available on prescription.

Because it helps to soften and lift the scaly surface skin affected by psoriasis, it also helps other medications to penetrate the skin, helping them to be more effective. For this reason, it is often used in association with medications containing prescription topical steroids or over the counter products containing tar.

You might experience some side effects from salicylic acid, especially when using products with higher concentrations as it can cause irritation, redness and dryness.

Alternatives to salicylic acid as a skin peel include lactic acid or beta hydroxyl acid peels.

Tar

Tar is a naturally occurring substance that has been used in medications for hundreds of years. Whilst coal tar is the type most usually used for psoriasis treatment, it can also be obtained from wood (usually pine wood). It helps to reduce the irritation and inflammation of the skin and slow down the growth of skin cells. This is important because it is this rapid growth that causes the plaques and scaling to form.

Products containing tar vary widely both in concentration of the active ingredient and in how pleasant they are to use – because tar can be both messy, cause staining and have an odour that some people find unpleasant – either way, it is certainly very distinctive.

Topical medications containing tar are designed for a variety of uses. Always follow the directions on the particular product pack that you are using. Usually skin treatments need to stay on for more than a couple of hours whilst shampoos need to be left on the hair for up to ten minutes or so.

You might notice side effects of irritated, dry or reddened skin so before your first use it is always a good idea to test it out on an inconspicuous patch of skin such as in the crook of your elbow. If you do experience redness, wait for this to resolve before trying again but this time, use a moisturizer on your skin first as this often enables users to tolerate a product well.

Another problem with using tar medication products is that they can cause staining. For this reason, if you are using a product on your skin, let it dry thoroughly in the air before dressing or getting into bed as it can stain clothing and bed sheets. You could also try wearing cotton socks or gloves for psoriasis lesions on the feet legs and hands after application of tar treatments and pyjamas or a lounging suit for after treatment of other areas of your body. In addition, if you have grey or blonde hair (natural or bleached), and want to use a tar shampoo, use a gel product as it will be less likely to stain – but always read the directions!

One final word of warning, even after washing tar products off, your skin will remain more sensitive to sunlight for at least twenty-four hours. For this reason it is very important to limit your sun exposure and to protect yourself adequately with sunscreen to avoid burning.

Is Tar Carcinogenic?

Some people might have a reticence about using tar products because of fear of cancer. However, whilst it is probably a wise precaution to get your skin checked periodically by a dermatologist if you are a long-term user of coal tar products, the advice from the FDA is that in the concentrations found in OTC medications (up to 5%), coal tar is safe and that there is absolutely no evidence to suggest that these products might be carcinogenic.

Tar is also used in conjunction with treatment with UVB light in cases of severe psoriasis. Known as the Goeckerman regime, this treatment takes place under the supervision of a hospital or dermatologist and normally lasts around four weeks.

Learn more about this safe and effective treatment that is reported to have excellent results with patients experiencing relief in as little as a few days and remission for a minimum of six months and maximum of ten years according to Thomas Anderson M.D., Medical Director of the University of Michigan Dermatology Day Treatment Center, speaking in the video (above, right) about the Goeckerman Regime.

With the popularity of home phototherapy machines which are now widely available, many people are using a form of this therapy for themselves at home. However, there are significant risks of burning the skin and so if you want to try this for yourself, you should consult your doctor or dermatologist first to ensure that the regime you are considering will be safe for your skin.

If you do not want to use salicylic acid or tar and your psoriasis is mild, there are many natural remedies that will be effective in relieving irritation and inflammation, helping to remove the psoriasis scales and moisturizing the skin.

Among the most popular treatments are the Flexitol Cream and Wash and the Natralia eczema and psoriasis wash pictured right.

Also popular are Dead Sea Mud soaps and cleansing bars.

However, my personal recommendation would be to use a combination of the products from Regsor which will relieve existing irritation, inflammation and scaling and help to prevent recurrence. There is a gentle cleanser and a soothing cream plus an effective shampoo and a wonderfully soothing oil which can be applied to the skin or as a treatment to the scalp before shampooing.

If you are looking for natural topical treatments for psoriasis, look for zinc pyrithione, capsaicin, aloe vera or jojoba on the product labelling.

The importance of moisturizing in treating your psoriasis
It is very important as part of any treatment regime to keep your skin lubricated and hydrated. Not only will this help to sooth your skin but it will also help with the healing too.

Dermatologist advice is that greasier products are most effective and products used in the bath can moisturize as well as soothing and giving relief from the itching and irritation. There are skin lubricating oils you can add to the bath (don’t forget to always place a rubber bath mat in the bottom of your bath for safety to avoid the danger of slipping when using oils in the bath!).

In addition, salts, either Dead Sea salts or plain old Epsom Salts can help with removing scales and soothing itching. Always apply a good moisturizer when you get out of the bath.

I hope that the information I have provided on topical psoriasis medications has been helpful. If you have this skin problem, be sure to check out the over the counter treatment products and if you need something more potent, consult your Doctor or Dermatologist and the recommended web page resources that will provide you with further information and other people's experiences with these medications.

Please do bear in mind that not every product will work for everyone and a product that has worked well for you in the past may suddenly stop working! Treating psoriasis is an ongoing journey, you never get to the destination where it is 'cured' but you can experience long periods where your symptoms are extremely minor - or even, completely absent.

Finally, if you know of a treatment product that is available over the counter and which has worked for you, please let us know about it in the comments section below.