What are my options for topical psoriasis treatments?

People have been using topical medications to treat psoriasis for over a century. There are many different topical treatment options available. Some have been around for more than a hundred years, such as coal tar and anthralin. Others, such as corticosteroids and salicylic acid, have been around for decades. And a few are newer, such as calcipotriol, calcipotriol/betamethasone, and tazarotene.

Psoriasis occurs when the body's T-cells (immune system cells designed to fight infections) become overactive. This leads to increased growth of the skin's outer layer. The new skin cells grow faster than they can be shed, forming scales. Topical medications – medications that are applied to the surface of the body – work by acting on different parts of this process.

Topical medication

How it works

Calcipotriol

Controls skin cell overgrowth

Calcipotriol/ betamethasone

Controls skin cell overgrowth/reduces inflammation and itching

Corticosteroids

Reduces inflammation, slows down skin cell growth

Salicylic acid

Softens up psoriasis scales so they are easier to remove

Tazarotene

Believed to work by controlling skin cell overgrowth and reducing inflammation

Anthralin

Controls skin cell overgrowth

Coal tar

Controls skin cell overgrowth

Topical medications also differ in their side effects, how long it takes them to start working, and how long they should be used for. To learn more, read the next sections in this feature: "Treating psoriasis: It's all about timing," "Topical psoriasis treatments: What about side effects?" and "Questions to ask your doctor or pharmacist about psoriasis treatments."

All material copyright MediResource Inc. 1996 – 2022. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/healthfeature/gethealthfeature/Psoriasis-Spotlight-on-Topical-Treatment

Treating psoriasis: It's all about timing

When you start a new psoriasis treatment, one of the first things on your mind may be "When will it start to work?" You may also want to know how long you should continue to use the medication. The answers vary, depending on which topical medication you are using.

Calcipotriol starts to work after about 2 weeks. Maximum effects are seen after 6-8 weeks of treatment. The medication can be stopped once the psoriasis clears up. Sometimes, the psoriasis may return, in which case the medication can be started again. Calcipotriol is also available as a combination product with betamethasone. This combination medication works more quickly, with major improvements after one week and maximum effects in four weeks. Calcitriol is another psoriasis medication that is in the same class as calcipotriol.

Corticosteroids (also known as "steroids") come in different strengths, ranging from mild to very strong. Commonly used corticosteroids include hydrocortisone, betamethasone, amcinonide, and mometasone. They can also be used with air-tight dressings to increase their effects. The strength of the steroid and whether an air-tight dressing is used can affect how quickly the medication starts to work. When a strong steroid is used in combination with an air-tight dressing, it may be able to clear up psoriasis in one week. Corticosteroids can cause side effects (such as high blood pressure, unusual hair growth, loss of blood sugar control, muscle cramps, and weight changes) if they are absorbed into the body. This is more likely to happen if strong steroids are used with air-tight dressings, if a large body area is treated, or if treatment continues for a long time. Check with your doctor or pharmacist about how long you should continue to use corticosteroids.

Salicylic acid is often used in combination with other medications because it softens up psoriasis scales, allowing the other medications to reach the skin more effectively. Occasionally, your physician may ask your pharmacist to mix salicylic acid into a commercial preparation for added effect. Some products contain both salicylic acid and a topical steroid (e.g. betamethasone). If used for long periods of time, on large body areas, or under airtight dressings, salicylic acid could be absorbed into the body, leading to side effects such as ringing in the ears, nausea and vomiting, or confusion.

Tazarotene begins to work after one week of treatment. Symptoms usually continue to improve throughout treatment. Treatment is usually given for 12 weeks, and most people will have seen an improvement after 12 weeks of treatment. Some people continue to show an improvement for up to 12 weeks after the treatment is stopped. Tazarotene may be combined with other ingredients like topical steroids in certain products.

Anthralin clears up psoriasis in about 3 weeks. It has been shown to have few long-term side effects, so it may be safely used for longer periods of time.

Coal tar can clear up psoriasis in 3-4 weeks. If you use coal tar, your doctor may recommend that, every now and then, you take a break from using it.

Talk to your doctor or pharmacist about how long you should continue to use your topical psoriasis medication.

All material copyright MediResource Inc. 1996 – 2022. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/healthfeature/gethealthfeature/Psoriasis-Spotlight-on-Topical-Treatment

Topical psoriasis treatments: What about side effects?

The side effects of a topical medication depend on which medication you're using, the length of time it is used, your general health and underlying medical conditions, and whether you are using the medication appropriately.

Some side effects can occur with most topical medications. The most common of these is skin irritation. It's also possible to have an allergic reaction to the medication or its ingredients.

Other side effects are more specific to the medication itself. Some occur when the medication is used improperly or the dose is too high. Others can occur even when the medication is being used properly at the recommended doses.

Here are some of the most common side effects:

Common side effects of topical psoriasis treatments

Vitamin D derivatives (calcipotriol, calcitriol, etc)

Normal use

Skin irritation, allergic reactions

High doses / inappropriate use

With high doses: increased calcium in the blood (the doctor will keep an eye on this using blood tests)

Corticosteroids (stronger corticosteroids are more likely to have side effects than weaker corticosteroids)

Normal use

Thinning of the skin, stretch marks, redness, and easy bruising
If used on the face: pimples, redness, or visible blood vessels

High doses / inappropriate use

If absorbed through the skin (more likely with high doses, strong corticosteroids, using an airtight dressing, long treatment times, and treating large body areas): moon face (a rounding out of the face), increased blood pressure, muscle cramps, weight changes, loss of blood sugar control, or unusual hair growth

Salicylic acid

Normal use

Skin irritation or stinging

High doses / inappropriate use

If absorbed into the body (more likely with long treatment times, large body areas, or airtight dressings): ringing in the ears, confusion, nausea, or vomiting

Tazarotene

Normal use

Skin itching, redness, burning, and irritation; increased sun sensitivity

High doses / inappropriate use

With higher doses: skin pain, skin peeling, rash, dry skin, stinging, and high triglyceride levels (a type of fat found in the blood)

Coal tar

Normal use

Irritation of skin and hair follicles; staining of clothing and hair; increased sun sensitivity

High doses / inappropriate use

With very high doses (much higher than normally used): increased risk of skin cancer

Anthralin

Normal use

Skin irritation or redness; staining of skin, clothing, or hair

High doses / inappropriate use

No known long-term side effects

Some medications, such as corticosteroids and salicylic acid, can only be used over a small body area or for a limited period of time to protect from the side effects they would cause if absorbed into the blood. The maximum time period depends on many factors, including the size of the area to be treated, whether airtight dressings are used, and the person's age and general health. Check with your doctor or pharmacist to see how long you should be using your topical medication.

This is not a complete list of all side effects caused by topical psoriasis medications. Some people may experience side effects not listed above. Consult your doctor or pharmacist if you notice any symptoms that worry you.

All material copyright MediResource Inc. 1996 – 2022. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/healthfeature/gethealthfeature/Psoriasis-Spotlight-on-Topical-Treatment

Questions for your doctor or pharmacist about psoriasis treatments

Topical treatments work best when they are used properly. Your doctor and pharmacist can help you use your medication safely and effectively and give you a better idea of what to expect during treatment. Here are a few questions to ask:

  1. What is the name of my medication?
  2. How does my medication work?
  3. What is the proper way to apply my medication?
  4. When should I expect my medication to start working?
  5. What should I do if my medication doesn't seem to be working?
  6. What side effects should I watch for and what should I do about them?
  7. Can the medication stain my skin or clothes?
  8. If my symptoms improve, should I stop taking the medication? Or should I slowly ease off the medication? Or should I check with the doctor or pharmacist first?
  9. How long will I need to continue taking my medication?
  10. If I miss a dose, what should I do?
  11. Are there any groups of people that should avoid this medication (e.g., pregnancy, breast-feeding, certain health conditions)?
  12. Are there certain foods, drinks, activities, or other medications I should avoid while I'm using this medication?
  13. How should I store my medication?
  14. Are there other things I can do (such as lifestyle changes) to help with my symptoms and prevent flare-ups?

Preparing a list of questions ahead of time can help you to remember to ask all of your questions. You can use our list as a model, and add any new questions that you may come up with. You may also want to save it on your smartphone or tablet or have a friend come to your visit to take notes.

All material copyright MediResource Inc. 1996 – 2022. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/healthfeature/gethealthfeature/Psoriasis-Spotlight-on-Topical-Treatment