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Patient Information Leaflet

Topical Treatments for Psoriasis

What are the aims of this leaflet?   

Patients with psoriasis are usually treated with preparations that are applied to the skin. This leaflet has been written to help you understand more about these treatments. It tells you what they are, how they are used, and where you can find out more about them.

What are topical treatments?

Treatments that are applied directly to the skin are known as topical treatments. They are the mainstay of treatment for most patients with psoriasis. More severe psoriasis may need a variety of other treatments including ultraviolet light and special tablets. Details of these further treatments are given in a separate Patient Information Leaflet: “Treatments for moderate or severe psoriasis”. However, most patients on these further treatments will still need to use topical treatments.

What is psoriasis?

In brief, psoriasis is a common skin disorder affecting about 1-3% of the population. It occurs equally in men and women, at any age, and tends to come and go unpredictably. It is not infectious and does not scar the skin. Patches of psoriasis are red and covered by silvery white scales. They usually come up on the knees, elbows, trunk or scalp, though any areas of the skin can be involved.

The exact cause of psoriasis is not known, but it does tend to run in families.  However the psoriasis of those with a genetic susceptibility to it may appear only if it is triggered by an outside event such as a sore throat, stress or an injury to the skin. 

Can psoriasis be cured?

Treatments for psoriasis are usually effective. However, even if your psoriasis goes away after treatment, there is a tendency for it to return. This may not happen for many years, but can do so within a few weeks. There is no evidence that any treatments alter the prognosis, so delaying treatment or using treatment early doesn’t affect the outcome.

What are the main topical treatments used for psoriasis?

Quite often different treatments will be recommended for different sites and for most stubborn areas combinations of different treatments may produce better results. They include the following:

• Emollients (moisturisers). Emollients help to moisturise dry skin.  They ease itching, reduce scaling, soften cracked areas and help the penetration of other topical treatments. They should be used as a soap substitute when bathing or washing, and should also be put on before anti-psoriasis treatment. It is usual to allow about 30 minutes after applying an emollient before applying other anti-psoriasis treatment. Very mild psoriasis may respond to treatment with emollients only.  Simple emollients can reduce scaling. They can be used as often as needed. 
  
• Emollients containing salicylic acid. Preparations containing salicylic acid can help reduce excessive scaling but may sometimes irritate the surrounding skin.
  
• Topical steroids. These are sometimes helpful, but only on localised lesions. The weaker steroids often do not work very well for thick patches of psoriasis, but may be more effective on the face or in the skin folds (e.g. under the arms) for short courses. The stronger steroids may be useful on palms and soles. Their use needs to be closely monitored by your doctor. There is also a tendency for psoriasis to return quickly when topical steroid treatment stops. 
  
• Tar preparations. Your doctor may prescribe a medicated tar bath that will help to remove loose scales from the patches of psoriasis. Other tar preparations take the form of creams or ointments or shampoos. These help most patients, but many find them messy and they can stain clothing. Crude tar, which is messy, can be applied by a dermatology nurse in a hospital setting.
  
• Dithranol. Dithranol is good for chronic scaly psoriasis in select areas and can be prescribed for use at home. Dithranol is almost always used as short contact therapy and by trained nursing staff.
  
• Short contact dithranol therapy. The dithranol is applied, sparingly, only to areas of skin affected by the psoriasis. It should be rubbed in gently until it is absorbed. The dithranol should be removed after the prescribed length of time (from 10 - 60 minutes) according to the manufactures instructions.
  Dithranol stains clothes, and you should therefore wear old clothes whilst the treatment is on the skin, though you can still continue with your daily activities. You should also clean the bath or shower immediately with a proprietary cleanser to avoid permanent staining. Treatment is usually carried out once a day. As the psoriasis clears, you will notice that the treated areas stain brown, but this will gradually fade after treatment is complete.
  Occasionally dithranol irritates the skin, causing inflammation and soreness in and around the treated areas. It is avoided on the face and the body folds. 
  
• Vitamin D analogues. Preparations based on variations of vitamin D (calcipotriol, tacalcitol, and calcitriol) have been introduced with considerable success. They are helpful, safe and cosmetically acceptable. They are not used during pregnancy and breastfeeding. Treatment is applied either once or twice a day, and can be continued for as long as required. Some Vitamin D analogues are combined with steroid ointments and are used in the short term.
  
• Vitamin A analogues. Tazarotene is a vitamin A gel that is applied once daily to patches of psoriasis. It should not be used on the face or skin folds or on large areas of the body, where it can cause irritation. Avoid use if you are pregnant or breastfeeding.

The treatment of psoriasis on the limbs and trunk will usually be with the preparations described above, and prescribed by your doctor, but some areas need special treatments:

Where can I get more information about topical treatments for psoriasis?

Links to patient support groups:

The Psoriasis Association
Dick Coles House
2 Queensbridge
Northampton, NN4 7BF
Tel: 0845 676 0076
Web: www.psoriasis-association.org.uk

Psoriatic Arthropathy Alliance
PO Box 111
St Albans
Herts, AL2 3JQ
Tel: 01923 672 837
E-mail: info@paalliance.org
Web: www.paalliance.org

Psoriasis Scotland Arthritis Link Volunteers
54 Bellevue Road
Edinburgh, EH7 4DE
Tel: 0131 556 4117
E-mail: bellevue@rapidial.co.uk
Web: www.psoriasisscotland.org.uk

Other information sources:

www.psoriasissupport.com

The British Skin Foundation fund vital research into all skin diseases. To find out how you can help, please visit the British Skin Foundation website here.

This leaflet aims to provide accurate information about the subject and is a consensus of the views held by representatives of the British Association of Dermatologists: its contents, however, may occasionally differ from the advice given to you by your doctor. 

This leaflet has been assessed for readability by the British Association of Dermatologists' Patient Information Lay Review Panel 

BRITISH ASSOCIATION OF DERMATOLOGISTS
PATIENT INFORMATION LEAFLET
PRODUCED AUGUST 2004
UPDATED SEPTEMBER 2010