How topical psoriasis treatments work

What are topical treatments, and which ones are available in Canada?

Topical psoriasis treatments are creams, ointments, and lotions that are applied to the areas of the skin or scalp affected by psoriasis. They work only on the area where they are applied.

Topical psoriasis treatments available in Canada include:

  • Corticosteroids
  • Vitamin D3 analogues
  • Calcineurin inhibitors
  • Tazarotene
  • Emollients
  • Salicylic acid
  • Coal tar
  • Anthralin

How do topical treatments fit into psoriasis treatment? When are they used?

Topical treatments are usually used for mild-to-moderate psoriasis and are often the first type of treatment that is tried. They may be used alone or in combination with other treatments, and if they are not effective, your doctor has other choices, such as medicines that are swallowed or injected (systemic medications) or another option known as light therapy. In contrast to topical treatments, which work directly at the area where they are applied, systemic medications are absorbed into the bloodstream and work internally in the body. Systemic medications include biologics (such as adalimumab, infliximab and etanercept) and non-biologics (such as acitretin, cyclosporine, and methotrexate).

How do topical treatments work?

The cause of psoriasis is not completely understood, but it's believed that T cells, a part of the immune system, become over-stimulated and force your skin cells to grow too quickly, interfering with the natural growth cycle of the skin. This leads to the red, scaly skin patches found on the scalps and bodies of people with psoriasis. Topical psoriasis treatments act on different parts of this process, depending on which one is used, but all work only on the area where they are applied.

Each topical medication has a slightly different action:

  • Corticosteroids work by reducing inflammation (skin redness and irritation) and slowing down skin cell growth.
  • Vitamin D3 analogues control abnormal skin cell growth.
  • Calcineurin inhibitors help control inflammation, itchiness or redness.
  • Tazarotene reduces inflammation and helps control skin cell growth.
  • Emollients reduce scaling.
  • Salicylic acid makes psoriasis scales softer and easier to remove. Once the scales are removed, other medications can reach the affected areas more effectively.
  • Coal tar slows down the growth of skin cells.
  • Anthralin helps control the growth of skin cells so they grow at a more normal rate.

All material copyright MediResource Inc. 1996 – 2021. 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-Topical-Treatment-FAQ

Proper use of topical psoriasis treatments

Corticosteroids

Corticosteroids are most effective when applied overnight and covered with airtight dressings. These dressings are changed in the morning, and they help the medication sink into the skin. Apply a thin layer of corticosteroid cream or ointment to the affected areas as directed by your doctor. Many people overuse these products, but using more than required won't make the medication work better or faster – it just wastes the medication. Ask your pharmacist or doctor how much to use. Wash your hands after applying corticosteroids. To avoid unwanted side effects, apply only a thin layer; do not use the medication more often or longer than your doctor recommends.

Calcineurin inhibitors

Calcineurin inhibitors (e.g., tacrolimus, pimecrolimus) are generally well-tolerated. They are not as effective as corticosteroids, but may help to avoid the complications of corticosteroids when applied to face or skin folds. Protect your skin with a sunscreen of at least SPF 15 when spending time outdoors, since these products can make your skin more sensitive to the sun.

Calcipotriol

At the start of treatment, calcipotriol is usually applied to the affected areas twice daily, then when the treatment has started to work well, it should be applied once daily. When applying it to the scalp, apply after washing your hair rather than before so that the medication is not washed away. Calcipotriol-betamethasone is applied once daily to the affected areas. Like most creams and ointments, you need to wash your hands after you apply calcipotriol or calcipotriol-betamethasone to remove any traces of medication so that you avoid transfer to the eye or a mucous membrane such as the mouth.*

Coal tar

Apply coal tar products to the affected area once daily. Be sure to apply it in the direction of hair growth and leave it on for at least 2 hours (or overnight). Since some coal tar products have a strong odour, you may wish to apply it at bedtime so that you do not need to "wear" it during the day. If you are using coal tar shampoo, apply it after wetting your hair, leave it on for 5 to 10 minutes, then rinse thoroughly.

Applying coal tar to broken skin or delicate areas such as the eyes or the inside of the nose or mouth may cause burning, stinging and irritation. Wash your hands after applying coal tar to avoid transfer to these areas or to clothing, since it will leave a stain. Protect your skin with a sunscreen of at least SPF 15 if you go outside, since coal tar can make your skin more sensitive to the sun.

Anthralin

Apply a thin layer of anthralin once daily to the affected areas and rub it in gently but thoroughly. Your doctor may recommend that you apply it at bedtime and remove it in the morning, or that you apply it and then wash it off after half an hour. You may be instructed to use an airtight dressing over top of the anthralin. Do not do this unless your doctor recommends it. To avoid irritation, avoid applying dithranol to your eyes, genitals, face, skin folds, or broken skin. As anthralin can stain skin, clothing, and surfaces, wash your hands well after applying it. To avoid staining your fingers, you may want to wear plastic gloves while applying anthralin.

Salicylic acid

Apply salicylic acid to affected areas as directed by your doctor. Many different salicylic acid products are available, so talk to your doctor or pharmacist to make sure you understand the instructions for your particular product. Do not apply it to broken skin, your eyes, inside your mouth, or inside your nose, as this may cause irritation. It's also important to wash all medications off your hands after applying salicylic acid.

Tazarotene

Apply a thin layer of tazarotene to the affected areas once daily before bedtime. Wash your hands after applying. Since tazarotene can make your skin more sensitive to the sun, apply sunscreen with at least SPF 15 before going outside.

*Please note: These are general instructions based on how the medications are usually applied. If your doctor recommends using the medication in a different way than the instructions listed here, follow your doctor's recommendations.

All material copyright MediResource Inc. 1996 – 2021. 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-Topical-Treatment-FAQ

Side effects of topical psoriasis treatments

What are the long-term side effects of topical steroids? What can I do to avoid them?
Topical steroids can have serious side effects if they are absorbed into the bloodstream. This can happen if they are used for a long time over large areas of the body or if very potent steroids are used inappropriately. Other things that increase the risk include using airtight dressings and applying the steroids to broken skin.

Side effects may include:

  • skin changes, including thinning, redness, and easy bruising
  • high blood pressure
  • moon face (a more rounded face)
  • loss of blood sugar control
  • unwanted hair growth
  • glaucoma (increased pressure in the eye fluid) or cataracts (clouding of the clear part of the eye, which can lead to blurry vision, poor night vision, and "cloudy" vision)
  • muscle weakness or damage

To reduce your risk of side effects:

  • Don't use topical steroids for any longer than recommended by your doctor.
  • Use the amount of medication recommended by your doctor or pharmacist.
  • Apply only a thin layer of steroid medication to the skin.
  • Apply the medication only to the areas affected by psoriasis.
  • Don't use an airtight dressing over the topical steroids unless recommended by your doctor.
  • Avoid using topical steroids on broken or damaged skin.
  • Don't stop using topical steroids suddenly. Ask your doctor how to stop the medication safely and gradually.

I have been using salicylic acid for psoriasis. Lately I've had ringing in my ears. Could this be related to the medication?
Salicylic acid may cause ringing in the ears, but this usually doesn't happen unless large amounts of salicylic acid have been absorbed into your body. This is rare when using salicylic acid only on the skin and scalp. Things that can increase the risk include using salicylic acid for a long period of time, over a large body area, under an airtight dressing, or on broken or damaged skin. These things can all cause salicylic acid to be absorbed into the body.

Many other things can also cause ringing in the ears, so it's important to visit your doctor for a proper diagnosis.

I've just started using tazarotene and my skin is very red, itchy and irritated. Is this normal? What can I do?
Tazarotene has been reported to cause skin redness, irritation, and itching. The risk of these side effects is related to the dose of tazarotene, and unaffected skin is more likely to be irritated by the medication. Be sure to apply only a thin layer of medication, don't use it more often than recommended by your doctor, and avoid applying to unaffected areas of skin. Tazarotene can also make your skin more sensitive to the sun, which can worsen the skin irritation, so apply a sunscreen with at least SPF 15 before going outside.

If these tips don't help, check with your doctor about other ways to manage the skin irritation. This may include reducing the dose of tazarotene, applying it less frequently, stopping treatment for a while to give the skin a rest, or switching treatments.

All material copyright MediResource Inc. 1996 – 2021. 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-Topical-Treatment-FAQ

Time to talk to your doctor about your psoriasis?

Your psoriasis treatment needs may change over time. To make sure your treatment keeps up with your needs, be sure to consult your doctor if any of the following apply to you:

  • your psoriasis seems to be getting worse
  • you have started a new treatment and aren't sure whether it's working
  • you are concerned about side effects from your treatment
  • your treatment seems to be less effective than usual
  • you are pregnant or breast-feeding
  • you have started any new medications (these may interact with your psoriasis treatment)
  • you have developed any new medical conditions (these may affect the safety of your treatment)

Your doctor can help you find a safe, effective psoriasis treatment that works for you. The key to making the most of this valuable resource is to know when to consult your doctor. Talk to your doctor if any of the situations above describe you.

All material copyright MediResource Inc. 1996 – 2021. 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-Topical-Treatment-FAQ