What Are Topical Treatments For Psoriasis?

What are topical treatments?

Psoriasis is an autoimmune condition in which chronic inflammation in the body causes symptoms called plaques to appear on the skin. It is a lifelong condition where symptoms can improve for periods of time or flare-up in response to treatment¹.

There are many treatment options that people with psoriasis can use to control their symptoms and manage the condition². These include:

• Prescription and over-the-counter topical treatments
• Systemic medications taken by mouth or through an injection, which affect the way the immune system functions to improve symptoms
• Light therapy
• Biologics

Topical treatments, or medications applied to the affected skin, are typically the first type of treatment a person with psoriasis will try. They come in many forms including creams, foams, lotions, and shampoos. Prescription topical treatments generally work by slowing down the excessive cell reproduction and inflammation associated with psoriasis.

What are common topical treatments for psoriasis?

• Topical corticosteroids
• Dovonex (calcipotriene)
• DUOBRII (halobetasol propionate and tazarotene)
• Taclonex, Enstilar, Wynzora Cream (calcipotriene and betamethasone dipropionate)
• Vectical (calcitriol)
• Tazorac (tazarotene)
• Zithranol (anthralin)
• Protopic (tacrolimus)
• Elidel (pimecrolimus)

What are topical corticosteroids?

Topical corticosteroids are the most commonly used treatment for psoriasis². They work by reducing the inflammatory response of the body in order to decrease the swelling, redness and itching of plaques on the skin. They come in a range of strengths and can be used alone or in combination with other treatments.

The following are a few types of corticosteroids used for psoriasis treatment:

• Halobetasol
• Clobetasol propionate
• Diflorasone diacetate
• Desoximetasone
• Desonide
• Hydrocortisone

These and many more corticosteroids come in different forms, strengths, and brand names to treat psoriasis.

What is Dovonex (calcipotriene)?

Dovonex is a topical medicine available by prescription for use on the skin, scalp, and nails. Dovonex is a synthetic vitamin D3 medicine made in a laboratory that works by slowing skin cell growth, decreasing inflammation, and removing scales from plaques². It is often used with other treatments in order to increase its effectiveness.

Dovonex is generally well tolerated by most patients. Some side effects of the drug included elevated levels of calcium in the blood when the medication is used on a large area of the body and skin irritation on areas where the medicine is applied. Less commonly dry skin, peeling, stinging, tingling, skin rash and worsening of psoriasis symptoms have been reported.³

What is DUOBRII (halobetasol propionate and tazarotene)?

DUOBRII is a prescription lotion developed to treat the symptoms of psoriasis. DUOBRII combines two medications: halobetasol propionate and tazarotene. Both are available as separate medicated lotions to treat the disease, but each has limitations. The combination of medicines in DUOBRII offers the benefits of both medications (a corticosteroid plus a retinoid) while reducing the side effects of taking either one in concentrated form or over time.⁴

What are Taclonex and Enstilar (calcipotriene and betamethasone dipropionate)?

The topical treatments Taclonex and Enstilar are used on the skin and scalp to help slow skin cell growth, flatten plaques, remove scales, and decrease itching and inflammation associated with psoriasis. Both medications are a combination of calcipotriene, a vitamin D analog, and betamethasone dipropionate, a corticosteroid².

Common side effects for Taclonex and Enstilar include itching, skin rash, thinning of the skin, and a burning sensation. Less commonly reddening or change in color of the skin, inflammation of hair follicles, and blood vessel swelling have been reported on the sites of application⁵.

What is Vectical (calcitriol)?

Vectical is a form of vitamin D3 that is naturally occurring and available only by prescription. This medication comes in an ointment and helps control the excessive production of skin cells that lead to the build up and formation of psoriasis plaques².

The most common side effects include increase levels of calcium in the urine, itching and skin discomfort. Vectical may also increase ultraviolet light sensitivity. Vectical is not recommended for those who are pregnant or breastfeeding⁶.

What is Tazorac (tazarotene)?

Tazorac is a topical retinoid or vitamin A derivative that is available with a prescription to treat psoriasis. Its active ingredient, tazarotene, is thought to slow the skin cell growth that leads to the buildup of psoriasis plaques. Combining Tazorac with other psoriasis treatments may increase its effectiveness².

The most common side effects of Tazorac are skin irritation and dry skin. The treatment may also make skin more susceptible to sunburn. Those who are pregnant, who may become pregnant or are breastfeeding should not use Tazorac³.

What is Zithranol-RR (anthralin)?

Zithranol-RR along with Dritho-Creme HP, and Zithranol are brand names for the medications that contain anthralin as the active ingredient. Anthralin is a topical cream for both skin and scalp treatment. This medication works by decreasing the skin cell growth associated with psoriasis, but may take several weeks to see results².

No long-term side effects are known for anthralin; however, it can cause skin irritation and brown stains when in contact with skin, clothing, and light-colored hair. These stains will fade and disappear with time. Those with kidney conditions should not use anthralin⁷.

What is Protopic (tacrolimus)?

Protopic is the brand name for the topical treatment containing tacrolimus. It is sometimes used off-label to treat psoriasis. Although not specifically developed to treat psoriasis, tacrolimus works by affecting the immune system in such a way as to prevent the triggering of inflammation that causes plaques to form⁸. It is a type of medication called a calcineurin inhibitor.

Common side effects include a burning sensation, itching, flu-like symptoms, skin redness or rash, and headache. Less commonly more serious side effects occur. There is also an increased risk of certain cancers while using tacrolimus. Those who are breastfeeding should not use tacrolimus⁹.

What is Elidel (pimecrolimus)?

Elidel is a topical treatment sometimes used off-label to treat psoriasis. Its active ingredient is pimecrolimus, a type of drug called a calcineurin inhibitor that works by preventing the overactive inflammatory response of the immune system associated with psoriasis².

The most common side effects experienced by patients using pimecrolimus are headache, fever, stuffy/runny nose, cough and upper respiratory tract infection. Some serious, yet rare, side effects are associated with the use of pimecrolimus such as a higher risk for cancer. Those who are breastfeeding should not use pimecrolimus¹⁰.