A topical treatment is a medicated ointment, cream, lotion, or another product you can apply directly to your skin. Many cases of mild to moderate psoriasis may be treatable with topical medication.
Topical treatments for psoriasis typically work by reducing inflammation, slowing down the production of skin cells, and improving the skin’s appearance and comfort. The effectiveness of these treatments varies from person to person, depending on the severity of their psoriasis and other factors.
There are many topical treatment options for psoriasis currently available as prescription or over-the-counter products. Some of the most commonly used topical treatments for psoriasis include:
- topical corticosteroids
- calcineurin inhibitors
- vitamin D analogues
- coal tar
- salicylic acid
- anthralin
- tazarotene (Tazorac)
- tapinarof (Vtama)
- roflumilast (Zoryve)
Salicylic acid and coal tar are both available over the counter, but the others require a prescription. Ask your primary care doctor or a dermatologist whether you need a prescription to treat your psoriasis.
Topical treatments can be effective in managing psoriasis symptoms for many people. Usually, people use topical treatments to treat mild to moderate psoriasis, while more severe cases may require a combination of treatments, including:
- oral medications
- biologics
- light therapy
Some people usually tolerate topical treatments better than other treatments because they have relatively few side effects, are easy to use, and people can apply them directly to the affected area of psoriasis.
But if you have a large area of psoriasis involvement, applying a topical medication might be too difficult because many treatments require twice-daily application for several weeks.
It’s difficult to compare the effectiveness of topical treatments with other types of treatments, as each person’s experience with psoriasis can be unique. For some people, a topical treatment may provide significant relief, while for others, a different type of treatment may be more effective.
Yes. Many dermatologists start with topical treatments because they have fewer side effects than medication given by mouth or as an injection. The latter are systemic medications because the delivery of these drugs occurs throughout the body.
Topical treatments typically don’t interfere with systemic or light treatment and usually enhance treatment outcomes when used together.
Often, people with severe psoriasis use topical, systemic, and light treatments to treat symptoms more quickly. This way, people can feel more confident in their skin in the shortest time!
Many people can benefit from topical treatments, but there are a few exceptions.
Pregnant or chestfeeding people must not use certain medications, such as topical tazarotene (Tazorac), because doctors categorize it as “pregnancy category X,†meaning it’s unsafe to use while pregnant or chestfeeding.
Pustular psoriasis or erythrodermic psoriasis is severe and manageable with systemic medications. These conditions usually involve a large part of the body, making topical treatments difficult to apply.
Some people are allergic to certain ingredients in topical psoriasis treatments. Fragrances, cocamidopropyl betaine, and propylene glycol can cause an allergic skin reaction.
Other common skin irritants include:
- alcohol
- menthol
- detergents
- antiseptics
- eucalyptus oil
If you develop a rash from a topical psoriasis treatment, and you see these ingredients in the product label, stop using it, and speak with your doctor.
Treating psoriasis can be frustrating because it takes time to see the full effects of treatment. The length of time can vary, depending on the person and the severity of their psoriasis. Also, certain body parts like the hands and feet, which have thicker skin, take longer to get better than the scalp or face.
In general, it’s important to give a topical treatment at least 4–6 weeks to work before determining effectiveness. If there’s no improvement in your psoriasis after this time or if your psoriasis symptoms worsen, talk with your doctor about switching to a different treatment.
Signs that a topical treatment may be working include:
- improvement in the appearance of psoriasis plaques, such as less discoloration, scaling, or thickness
- reduction in itching or discomfort
- enhancement in overall mood and quality of life
Yes. Using a moisturizer and sunscreen can be great for almost everyone but especially important for people with psoriasis.
Moisturizing your skin can help reduce dryness and scaling, which can be particularly helpful for people with psoriasis. It’s a good idea for people to apply moisturizers liberally and frequently, especially after showering or bathing, to help lock in moisture.
Sunscreen is also important for people with psoriasis, as sunburn and other forms of skin damage can trigger or worsen psoriasis flares. It’s important to use a broad-spectrum sunscreen with an SPF of at least 30 and to reapply it regularly, especially if you spend time outdoors or swimming.
Remember to always be gentle while applying a moisturizer and sunscreen. Try to avoid rubbing or scrubbing your skin, which can cause irritation and inflammation and worsen your psoriasis. Instead, use a gentle, circular motion to apply the product and avoid any areas of broken skin or open sores.
You can apply topical treatments directly to your skin to treat psoriasis. There are many topical treatment options available, and research is ongoing for more innovation in psoriasis treatment in the future.
You may use topical treatments and other medications and therapies to treat psoriasis. Each case of psoriasis is different, so it’s a good idea to discuss your treatment options with a board certified dermatologist to get the optimal treatment plan for you.
Dr. Joan Paul is an ABMS board certified dermatologist who specializes in psoriasis, skin cancer, skin of color, and global health. She has also completed seven medical missions in the countries of Haiti, Trinidad & Tobago, Mexico, Malawi, Uganda, India, and Botswana.