What Are Over-The-Counter (OTC) Treatments?

Psoriasis is a chronic autoimmune condition in which inflammation inside the body causes symptoms called plaques to develop on the skin. Plaques are patches of skin that are red, thickened and covered with a layer of silvery scale.

Most people with psoriasis have a mild form of the disease, with symptoms that affect less than 3% of their bodies1. Mild psoriasis can often be treated effectively with topical medicines that are applied directly to the affected skin. People with more severe forms of psoriasis may use over-the-counter (OTC) medicine, or medicine that can be obtained without a prescription2.  OTCs include a range of topical treatments that are used to help soothe symptoms in addition to stronger systemic medicines that affect the way the immune system works to treat the underlying condition.

Several types of topical treatments are available over the counter in a pharmacy, drugstore, or supermarket. Stronger topical medicines may require a prescription from a healthcare provider.

Some over-the-counter (OTC) topical treatments that may be used to treat psoriasis plaques include:

  • Moisturizers and emollients
  • Salicylic acid
  • coal tar
  • itch relief products

Non-medicated topical moisturizers are frequently used as an adjunct therapy and may be used to help soften areas of plaque to help reduce pain, cracking and bleeding symptoms

What is Salicylic acid and how does it work to treat plaque psoriasis?

Salicylic acid is an OTC topical treatment that is approved by the US Food and Drug Administration (FDA) for treating psoriasis. It has been used by people with psoriasis for many years1. It is a type of treatment called a keratolytic, which also known as a peeling agent or scale lifter.

Salicylic acid works by helping the scaly outer layer of plaques to be shed from the skin. It can also have the effect of softening psoriasis scales, and some people find that it can also help to reduce itch2. It is available in many different forms, including:

  • lotions
  • creams
  • ointments
  • gels
  • plasters
  • solutions
  • soaps
  • shampoos (which can help with scalp itch)

A large number of products containing salicylic acid can be found in the United States. For many patients, salicylic acid is more effective when it is used in combination with other types of psoriasis treatments, such as topical corticosteroids and the prescription topical treatment tacrolimus. Researchers think that combination treatment is effective because the salicylic acid helps the other types of topical medicines to penetrate more deeply into the skin

If the salicylic acid preparation used to treat psoriasis symptoms is strong, it may irritate the skin if it is left on too long. Patients are usually advised not use salicylic acid on large areas of the skin (more than 20%) because it can be absorbed into the body and cause side effects. Salicylic acid can also make ultraviolet (UVB) phototherapy less effective, so it is recommended not to use it before UVB phototherapy treatments.

What is coal tar and how does it work to treat plaque psoriasis?

Coal tar is an OTC topical treatment that is made from coal. It has been used for treating psoriasis for more than 100 years, although it is currently less commonly used in the United States than it is in other countries. Coal tar works by helping to reduce some of the production of new skin cells that cause plaques to form1. It can also help to reduce itching, inflammation, and the thickness of plaques.

Coal tar products are available in various strengths and forms, including lotions, shampoos, and creams. These products are approved by the US FDA at strengths of between 0.5% and 5% coal tar. Some patients have a better response in their symptoms with lower strengths of the product2. Brand names for coal tar products include Neutrogena T/Gel (shampoo) and Psoriasin.

Using coal tar can cause side effects on the skin such as irritation, reddening, and dryness. Applying it on top of a layer of moisturizer can help to reduce those effects.

Coal tar can also make your skin more likely to sunburn, so it is important to use sunscreen and avoid the sun if possible unless directed otherwise by a doctor. Some patients dislike coal tar products because they have a strong smell and they can stain clothing, towels, sheets, and even light-colored hair3.

There are also combination topical treatments available that combine coal tar with salicylic acid, such as X-Seb T Plus, Pazol XS, and SLT.

What are the types of topical itch relief products and how do they work to treat plaque psoriasis?

Itching is one of the most common symptoms of psoriasis. The US FDA has approved various different kinds of OTC topical medicines for treating itch1, including:

  • hydrocortisone creams, ointments, solutions, gels, and lotions
  • calamine lotions
  • benzocaine gels and solutions
  • camphor lotions and ointments
  • menthol shampoos, creams, lotions, and gels

Another anti-itch product is made from capsaicin, and sold under the brand name Zostrix2. Capsaicin is the substance that makes chili peppers taste spicy, and when it is made into a medicine it can help to reduce itch on the skin. It can sometimes cause a temporary burning feeling when applied, but this usually goes away after a few days of treatment. Other types of anti-itch topical treatments can cause side effects of skin irritation and dryness3.

Written by: Anna Nicholson | Last reviewed: July 2016.
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