Topical psoriasis treatment includes corticosteroids, calcipotriol/calcipotriene, tazarotene, tars and anthralin. Tars and anthralin are discussed above.
Topical steroids are the most commonly prescribed psoriasis medications, and they are available as creams, ointments, gels, lotions, solutions, oils and shampoos. They can be used anywhere on the body. They work quite quickly, often within 1—2 weeks. However with long-term use, steroids often lose their effectiveness. Usually you won’t have any side-effects with short-term use. However, longer use, particularly with stronger preparations, may cause thinning of the skin, stretch marks, dilated blood vessels, rosacea, perioral dermatitis, bruising, hair growth, progression to a more active form of psoriasis (for example, pustular or erythrodermic psoriasis), increased susceptibility to infections, and a flare-up of the psoriasis when the medication is stopped.
Topical corticosteroids can be absorbed into the blood circulation and cause a number of side-effects in your body, particularly if you are treating large areas and/or using strong steroids. Only mild steroids should be used on the more sensitive skin, such as your face, and in skin folds. Stronger steroids are usually required elsewhere. Pulsed betamethasone diproprionate used three times, 12 hours apart is shown to be useful in maintaining psoriasis. This regimen is suitable for weekend use while non-cortisone can be used during the weekdays.
Calcipotriol/calcipotriene is a derivative of vitamin D, and it is available in a cream, ointment and scalp solution. The onset of action is usually slower (could take up to 2 months) than with topical steroids, but it is usually effective and safe for long-term use. Only 100 g/week should be used, as it is possible to alter your calcium metabolism with the risk of forming calcium kidney stones. Since it may cause irritation, it is not usually used on the face, genitals or in skin folds.
It can be combined with UVB therapy, and increases its effectiveness. UV light, salicylic acid, lactic acid, and tazarotene deactivate calcipotriol. It is compatible with tar gels that are used at the same time on the skin.
Tazarotene is a selective retinoid with properties that are similar to vitamin A. Tazarotene is available as a cream and gel. It is effective in the treatment of psoriasis, acne and photoaging. In the treatment of psoriasis, it may be used by itself or in combination with a corticosteroid cream or ointment, calcipotriol/calcipotriene or light treatment (UVB, PUVA). Irritation is common with tazarotene, but you can minimize this by applying a thin layer of the medication only to the patches and avoiding the uninvolved surrounding skin and/or protecting the surrounding skin with petrolatum. You should not use tazarotene on the genitals or in the skin folds. You should not use this medication if you are pregnant.
Click here to view the A-Detail™ on Dovobet®, a mix of calcipotriol and the corticosteroid betamethasone dipropionate.