September 2, 2014
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Topical medications for psoriasis

Topical medications are creams, ointments, and lotions applied to the skin. People quite commonly start their psoriasis treatment with topical medications. Topical medications should be applied as directed by your doctor or pharmacist.

Doctors may suggest a treatment plan that includes combining topical medications with each other (e.g., corticosteroids combined with vitamin D derivatives, vitamin A derivatives, salicylic acid, or coal tar) or with other psoriasis treatments (such as systemic medication or with light therapy).

Talk to your doctor about the most appropriate psoriasis treatment for you. With effective treatment and management, psoriasis lesions can be cleared.

Topical treatments can be prescription or non-prescription medications and include:

Topical corticosteroids

How they work
Topical corticosteroids work by decreasing inflammation, redness, and itchiness.

How they are used
Topical corticosteroids are usually applied sparingly to psoriasis lesions once or twice a day. Different strengths and formulations are used for different parts of the body. Usually, less potent corticosteroids are used for thin-skinned or sensitive areas (e.g., face, skin folds, groin, breasts). Stronger corticosteroids are used for short-term use on thicker skin (e.g., palms, soles).

There are many topical corticosteroids. They include amcinonide (Cyclocort® and generics), betamethasone dipropionate (Diprosone®, Diprolene®, and generics), betamethasone valerate (Betaderm®, Valisone®, and generics), clobetasol propionate (Dermovate® and generics), desoximetasone (Topicort® and generics), hydrocortisone (Emo Cort® and generics), and prednicarbate (Dermatop®).

Side effects of topical corticosteroids
Common side effects include redness, dryness, irritation, itching, burning, thinning of the skin, bruising, dilated blood vessels that are close to the skin surface, changes in pigmentation, excessive hair growth, skin infection, and stretch marks. If you apply topical corticosteroids to the face, rosacea (an inflammatory skin condition) or tiny red bumps around the mouth can occur.

Many side effects are manageable. Talk to your doctor or pharmacist if you are experiencing any side effects.

Warning: Suddenly stopping topical corticosteroids can cause a psoriasis flare-up, so do not change the way you are using them without talking to your doctor first.

This is not a complete list of all side effects, warnings, and precautions. For detailed and current information for each medication, see the Consumer Information section of the approved Product Monograph, which can be found on the Health Canada website.

Vitamin A derivatives

How they work
Vitamin A derivatives, or retinoids, such as tazarotene (Tazorac®), are believed to work by slowing down skin cell growth and reducing inflammation.

How they are used
A thin layer is applied once a day to the affected areas. Tazarotene is used on the body (not the face or skin folds).

Side effects of vitamin A derivatives
Common side effects with retinoids include itching, redness, burning, and irritation. They may also increase the skin's sensitivity to the sun, so you should avoid sunlight and tanning beds, and cover up when going outside.

Many side effects are manageable. Talk to your doctor or pharmacist if you are experiencing any side effects.

This is not a complete list of all side effects, warnings and precautions. For detailed and current information for each medication, see the Consumer Information section of the approved Product Monograph, which can be found on the Health Canada website.

Vitamin D derivatives

Vitamin D derivatives include calcipotriol (Dovonex®), which is a synthetic form of vitamin D, and calcitriol (Silkis™), a naturally occurring active form of vitamin D. These are not the same as the vitamin D you find in vitamin supplements taken by mouth. Calcipotriol is also available in combination with betamethasone as an ointment (Dovobet®) or a scalp gel (Xamiol®).

How they work
Vitamin D derivatives work by controlling the abnormal growth of cells to help flatten lesions and reduce scales.

How they are used
Vitamin D derivatives are usually applied twice a day to the affected areas of the body (not the face or skin folds). When used with a topical corticosteroid, calcipotriol and the corticosteroid should be applied once daily, at different times of the day (e.g., one in the morning and the other in the evening).

Side effects of vitamin D derivatives
Common side effects of vitamin D derivatives include skin irritation or discomfort, itching, flu-like symptoms, and skin infection. Combination products may include both vitamin D derivative side effects and topical corticosteroid side effects.

Many side effects are manageable. Talk to your doctor or pharmacist if you are experiencing any side effects.

This is not a complete list of all side effects, warnings and precautions. For detailed and current information for each medication, see the Consumer Information section of the approved Product Monograph, which can be found on the Health Canada website.

Anthralin

How it works
Anthralin, also known as dithranol, works by slowing the growth of skin cells that cause psoriasis lesions.

How is it used
Anthralin is usually applied once a day and can be applied to the body and scalp. It can be prepared as a compounded mixture by a pharmacist.

Side effects of anthralin
The most common side effect is skin irritation, especially to the normal skin surrounding lesions. It can also stain hair, skin, clothing, and bedding. Stained hair and skin will eventually fade.

Many side effects are manageable. Talk to your doctor or pharmacist if you are experiencing any side effects.

This is not a complete list of all side effects, warnings and precautions. For detailed and current information for each medication, see the Consumer Information section of the approved Product Monograph, which can be found on the Health Canada website.

Salicylic acid

How it works
Salicylic acid is a peeling agent that works by shedding the outer layers of the skin, helping to soften and remove psoriasis scales.

How it is used
Salicylic acid is usually applied once or twice a day to the body or once or twice a week to the scalp.

It is available without a prescription combined with other topical medications such as coal tar (e.g., Targel SA, Polytar AF®) and corticosteroids (e.g., Diprosalic®, Nerisalic®), or it can be prepared as a compounded mixture by a pharmacist.

Side effects of salicylic acid
Common side effects include skin drying, itching, redness, peeling, and stinging. Long-term use over large areas of the body may cause absorption of salicylic acid. Combination products may include side effects from the different medications that make up the combination (e.g., topical corticosteroid side effects and salicylic acid side effects for Diprosalic®).L

Many side effects are manageable. Talk to your doctor or pharmacist if you are experiencing any side effects.

This is not a complete list of all side effects, warnings and precautions. For detailed and current information for each medication, see the Consumer Information section of the approved Product Monograph, which can be found on the Health Canada website.

Coal tar

How it works
Coal tar (e.g., Targel, Doak Oil™) works by helping to slow the growth of skin cells and reducing inflammation, itching, and scaling.

How it is used
Coal tar is usually applied once a day to the affected areas of the body for 2 hours (not in skin folds) or to the scalp for 5 to 10 minutes. Some formulations can also be added to bath water.

It is available without a prescription, or it can be prepared as a compounded mixture by a pharmacist.

Side effects of coal tar
The most common side effects are sensitivity to sunlight, skin irritation, redness, dryness, and hair follicle inflammation. Coal tar also has an odour and can stain hair, skin, clothing, and bedding.

Many side effects are manageable. Talk to your doctor or pharmacist if you are experiencing any side effects.

This is not a complete list of all side effects, warnings and precautions. For detailed and current information for each medication, see the Consumer Information section of the approved Product Monograph, which can be found on the Health Canada website.

With all treatments, it is very important to follow the directions provided by your doctor or pharmacist.

The best treatment for you may depend on the severity of your psoriasis. Be sure to use the DLQI (Dermatology Life Quality Index) to determine the impact of your condition and work with your doctor to choose the most satisfactory treatment option.

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