Dermatology Made Simple: Management of Psoriasis : Topical Therapies

Topical therapies for Psoriasis

These treatments are applied directly to the skin surface.

These include:

Ointments

Creams

Lotions

Tars

Mechanism if action:

These treatments result in changes at and just below the skin surface.ie in epidermis and dermis.

Combination therapy is more effective than monotherapy.

Advantages of Topical treatments are as follows:

1.Cheaper form of therapy

2.No systemic side effects.

3.Easy to use as can be applied by oneself on diseased skin.

4.Effective in milder forms of disease

Disavdantages are:

1.Messy

2.Poor compliance

3.Decreased effectiveness of therapy with time.

4.Not effective in severe forms of disease.

Some characteristics of different forms of topical therapies:

Topical corticosteroids:

They reduce superficial inflammation within plaques.

They are applied on affected areas of the skin once or twice daily.

Are safe for use on face and flexural areas of skin.

Steroids of moderate intensity are most useful in chronic plaque psoriasis

Disadvantages:

1.Relapse occurs on cessation

2.Tachyphylaxis ( reduced potency on repeated use ) is observed.

Calcipotriol:

This is vitamin D analogue.

These are useful for mild to moderate plaque psoriasis.

Can cause mild irritation at site of application.

They are best used with other topical preparations.

Dithranol:

This is produced from araroba trees.

Is useful in chronic plaques psoriasis.

They stain skin and hair a purple brown color

They can cause irritation and burning of normal skin.

Strength varies from 0.1 % to 3 %.

Icthammol:

It is  a sulphur preparation.

It has anti-inflammatory properties.

Coal tar:

There are various coal tar preprations including ointments,pastes,paints,soaps and shampoo.

Coal tar preparations normalize keratinocyte growth patterns.

It is useful in chronic plaque psoriasis.

When combined with salicylic preparations,it is very effective for very thick plaques.

Emollients:

They prevent cutaneous fluid loss and relieve itching.

They restore function of skin as a barrier.

They are readily available and a cheap form of treatment.