Psoriasis Treatment Topical Therapy
Topical therapy is appropriate for patients with limited skin involvement and in combination with other modalities. Topical preparations include shampoos, foams, solutions, creams, ointments and sprays. Patients must be provided with an adequate amount of the preparation to treat the involved areas for the amount of time directed.
Several active ingredients have been compounded into these various preparations. Coal tar containing products are effective, but somewhat messy to use and irritating to the skin. Odor is also an issue. Anthralin containing preparations are also effective, but staining of skin and clothing limits compliance.
Dovonex is calcipotriene is a vitamin D3 analogue preparation which can be applied once or twice daily as tolerated in amounts up to 100 g/week. It is important to confine medication to the plaques so as to minimize local irritation and erythema.
Tazorac is tazarotene, a synthetic retinoid, in gel or cream once or twice daily is effective. Again confining application to the plaques minimizes local irritation of the surrounding skin.
Topical corticosteroids in Groups 1 through 5 have been mainstays of psoriasis treatment for several decades. Their direct anti-inflammatory effect treats psoriasis. There is risk of skin atrophy with long-term use. It is important to limit duration of use, quantity and potency of topical steroids in the long-term management of psoriasis. For this reason, topical steroids are often combined with other topical agents such as tazarotene and calcipotriene which do not risk skin atrophy. The topical steroid reduces the irritation from these agents as well.