Psoriasis Treatment: Medicine Applied to the Skin
Mild to moderate psoriasis is
frequently treated with medicine that can be applied to the
psoriasis. Your dermatologist may call this type of medication a
“topical” or “topical preparation.” When treatment that is applied
directly to the skin is not effective by itself, this treatment may
be combined with another type of psoriasis treatment such as light
therapy or an oral (taken by mouth) medicine. The U.S. Food and Drug
Administration (FDA) approved these topical medicines for treating
Anthralin has been used to treat psoriasis for more than 100 years
and is effective on plaque and guttate forms of psoriasis.
Newer preparations and treatment methods minimize the traditional
side effects of skin irritation and staining. In more severe
psoriasis, anthralin may be used with ultraviolet light.
How it works: It is believed to
act on psoriatic lesions by normalizing the growth rate of skin
cells (keratinocytes), which decreases the skin’s rapid growth rate
and reduces inflammation.
Can produce skin irritation
May cause brown stains on skin,
clothing and everything it contacts, including bathroom
One of the oldest treatments for psoriasis, coal tar is effective
for mild to moderate plaque psoriasis, and new formulations show
promise in treating moderate to severe plaque psoriasis. Tar
shampoos are effective for scalp psoriasis.
Coal tar comes in numerous
preparations, and some of these are available over-the-counter.
These different formulations are used to treat scaling, inflammation
and itching. One preparation is added to bath water. As the patient
soaks, the tar helps to slow down or stop the formation of scale as
well as soften thickened lesions.
Best results are typically seen when
use is supervised by a dermatologist. While effective, patients
often prefer other topical medications because coal tar has an
unpleasant odor and can stain.
In severe psoriasis, coal tar may be
combined with ultraviolet (UV) light therapy. This combination
therapy, known as the Goeckerman Treatment, has been shown to clear
psoriasis in many patients in about 3 to 4 weeks. To receive
treatment, patients must go to specialized centers for daily
How it works: It is believed
that coal tar decreases the rapid growth of the skin cells that
When used with UV light therapy,
requires daily visits to treatment center
Possible skin irritation
Can stain skin and clothing
Corticosteriods, also known as steroids and glucocorticosteriods,
remain the most frequently prescribed treatment for mild to moderate
psoriasis. They are very effective in reducing inflammation, itch
and the rapid growth rate of skin cells. Topical corticosteroids
vary in potency—from extremely mild to very strong—and come in
several forms, including lotions and ointments. While quite
effective, topical corticosteroids are usually prescribed for a
select purpose for a limited period of time due to potential side
effects. They are frequently used in combination with other agents.
How it works: Corticosteroids
decrease the rate at which skin cells grow and reduce inflammation.
Quickly reduces inflammation and
Effective at clearing lesions
Variety of potencies and forms
Easy to use
Not recommended for long-term use
Overuse may cause thinning of the
skin, dilated blood vessels, stretch marks, infection and
excess body hair
Must be used with caution around
May suppress growth in children
May become ineffective with
Tazarotene is a man-made retinoid (vitamin A derivative) approved
for treatment of mild to moderate plaque psoriasis. It has also been
reported to be effective in treating psoriasis of the nails.
Available by prescription only, tazarotene comes in cream and gel
form. Local skin irritation is a common side effect. When used in
combination with topical corticosteroids, the effects of tazarotene
are enhanced, skin irritation is decreased and some of the side
effects from the corticosteroids are reduced. Tazarotene is not
recommended for use in areas where skin folds occur due to possible
skin irritation. Although the possibility of birth defects is much
lower for topical retinoids than for the systemic forms, women who
are pregnant or who may become pregnant should use topical retinoids
only under close medical supervision.
How it works: Retinoids
normalize DNA activity in skin cells, which decreases the rapid
growth of skin cells.
Calcipotriene is a man-made form of vitamin D approved for the
treatment of mild to moderate plaque psoriasis. It may be combined
with other topical agents or with phototherapy. Using caclipotriene
and topical corticosteroids together produces fewer side effects
than treating with either agent alone. However, knowledge of how
different topicals interact with calcipotiene is required when
calcipotriene is used in combination therapy because several
topicals, including salicylic acid, inactivate calcipotriene.
Calcipotriene is not the same as the vitamin D that one buys in a
drug or health-food store; that vitamin D is of no value in treating
How it works: Is thought to slow
down the rate of skin cell growth and reduce skin inflammation.
Mild side effects
Can be used in areas where
corticosteroids may not be recommended, such as eyelids and
areas where skin folds occur
Long remission periods when used
in combination with corticosteroids
Can cause skin irritation
Other topicals, such as salicylic
acid, can inactivate it
May affect growing bone when used
in large amounts so special care should be used when treating
Topical Medications in Clinical
Research shows that 2 topical medications, pimecrolimus and
tacrolimus, may be effective in treating psoriasis. These 2
medications are FDA approved for treating eczema. In clinical
trials, pimecrolimus and tacrolimus are showing much promise in
treating inverse psoriasis with little skin irritation.
Both pimecrolimus and tacrolimus are
topical immunomodulators (TIMs). When applied to the skin, they
exert a powerful anti-inflammatory effect. Tacrolimus can be safely
applied to the eyelids and other areas around the eye—where topical
corticosteroids must be used with caution. Side effects tend to be
mild and include minor itching and a sensation of warmth after
How they work: TIMs interfere
with the activation of T cells, a type of white blood cell
responsible for triggering immune responses that contribute to the
development of psoriasis.
Moisturizers and Scale Removers
These products come in several forms, including creams, gels,
lotions and shampoos. By themselves, they do not control psoriasis;
rather, they help to lock in water and soften or remove scale, which
allows topical medications to penetrate more deeply. These topical
products may also reduce the redness and itching by keeping skin
Salicylic acid is often used to
effectively remove scale. It is available both by prescription and
over-the-counter and comes in many forms, including lotion, gel,
soap and shampoo. Potential side effects include skin irritation, a
possible worsening of psoriasis and salicylism, a toxic syndrome
that causes ringing in the ears, upset stomach and vomiting.
Gribetz, C. et al. “Clearing Psoriasis: A New Era of Optimism.”
Contemporary Dermatology 2003: Vol. 1, No. 1: 1-8.
All content solely
developed by the American Academy of Dermatology
For an overview, visit
the AAD pamphlet
Psoriasis and Psoriatic Arthritis.