Psoriasis - Topical Medications

Topical Medications

Topical medications are those applied only to the surface of the body. They come in the following forms:

• Creams
• Foams
• Gels
• Lotions
• Occlusive tapes
• Ointments
• Shampoos
• Solutions
• Sprays

In general, topical treatments are the first line for mild-to-moderate psoriasis, but they may also be used, alone or in combination, with more powerful treatments for moderate-to-severe cases. Topical medicines rarely clear up symptoms completely, however.

Topical Corticosteroids

Topical corticosteroids are the mainstay of psoriasis treatment in the United States. These drugs work for most patients because they:

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• Decrease inflammation
• Block cell production
• Relieve itching

Corticosteroids are available in a wide range of strengths, and are generally given as follows:

• Less potent drugs are used for mild-to-moderate psoriasis.
• Stronger drugs are reserved for more severe disease.

Topical steroids are often rated by how strong or potent they are:

• Low potency (some are available over-the-counter)
• Low-to-medium potency
• Medium- to upper-mid potency
• High potency
• Very high potency

In the past, topical steroids were used twice a day. For some patients, certain drugs may work just as well if applied once a day. Both high-potency steroids, and possibly medium-strength steroids, such as triamcinolone (Aureocort, Tri-Adcortyl), may be beneficial as a once-daily treatment.

However, corticosteroids used alone are not enough for most patients. Combining topical steroids with other topical drugs (see below) is often needed. Many patients also need oral medicines.

Side Effects. The more powerful the corticosteroid, the more effective it is. But more powerful steroid medications also have a higher risk for severe side effects, which may include:

• Acne
• Burning
• Dilated (widened) blood vessels
• Skin dryness
• Skin irritation
• Loss of skin color
• Thinning of the skin; skin may become shiny, fragile, and easily broken

Loss of Effectiveness. In most cases, patients become tolerant to the effects of the drugs, and the drugs no longer work as well as they should. Some experts recommend using intermittent therapy (also called weekend or pulse therapy). This type of treatment involves applying a high-potency topical medication for 3 full days each week.