Psoriasis is a skin condition that causes the skin to appear scaly and inflamed. It occurs when the immune system goes into overdrive, causing skin cells to multiply rapidly.
Psoriasis can affect different parts of the body, including the scalp, elbows or knees. Common symptoms include scaly, dry, cracked or itchy skin. People with lighter skin tones may develop red or pink patches on the skin, and people with darker skin tones may develop purple or brown patches on the skin.
There is no known cure for psoriasis, but treatment is available to help manage symptoms. This includes over-the-counter creams and prescription creams.
For many people with mild psoriasis, dermatologists (doctors who specialize in skin, hair, and nail conditions) may suggest over-the-counter (OTC) creams to help manage symptoms. These creams can reduce itching, protect the skin barrier and exfoliate the skin. They may take longer to work than prescription creams.
1. Steroid creams
Mild corticosteroids, such as hydrocortisone cream, can be purchased over the counter to help manage psoriasis symptoms. Prescriptions are required for stronger corticosteroid creams.
Hydrocortisone creams reduce inflammation, which can help reduce redness, swelling, and itching. These creams usually work well on several areas of psoriasis. For larger patches, you will need prescription steroids. It is best to use steroid creams only on the affected areas.
Side effects of hydrocortisone creams include acne, burning or dryness of the skin, unwanted hair growth, and skin changes.
2. Scale softeners
Softeners/scale removers, also known as keratolyticsit can help soften the scales and remove the hardened outer layer of skin.
Scale softeners contain ingredients such as urea and salicylic, glycolic and lactic acids. A dermatologist may prescribe calculus softeners to help other topical medications work better. It is recommended that you take a warm, 15-minute bath before using the scale softener for best results.
One downside to softeners, especially creams that contain salicylic acid, is that they can be too harsh on the skin. Using these creams more than necessary can also make psoriasis symptoms worse. Serious side effects include ringing in the ears, rapid breathing, and confusion.
3. Coal tar
Coal tar is a byproduct of coal, created during the production of coke (a solid fuel made mostly of carbon) and coal gas.
Certain coal tar preparations can be used to treat skin conditions such as psoriasis. People have used coal tar for psoriasis for over 100 years, and it is approved by the United States Food and Drug Administration (FDA).
Coal tar creams can be an effective treatment for psoriasis symptoms, even in hard-to-treat areas of the palms and soles.
Some people may see complete skin clearing with coal tar, but the degree of success may depend on the strength of the tar lotion. One study found that a lotion with 1% coal tar worked better than a lotion with 5% coal tar. Ask your dermatologist what strength would be best for you.
Coal tar has some disadvantages, including unpleasant odor, soiling of skin and clothing, and skin irritation. Stop using coal tar if you experience severe burning, stinging, or worsening of psoriasis.
Coal tar may not be a good choice if you are sensitive to the sun or take medications, such as retinoids, that make you more sensitive.
4. Anti-itch creams
Anti-itch creams that contain ingredients like calamine, camphor, and menthol can help relieve psoriasis itching.
These products can irritate or dry out your skin, which in turn can make your psoriasis symptoms worse. It is best to use a moisturizer when using an anti-itch cream.
For moderate to severe psoriasis, your healthcare provider may recommend prescription-only creams or as an adjunct to other treatments. They may also prescribe these stronger creams if OTC options are not effective for your case.
Some prescription creams that can help treat psoriasis include:
1. Topical steroids
Steroids come in different strengths and potencies. Prescription steroids are stronger and are preferred for the treatment of moderate to severe psoriasis. They help reduce inflammation and prevent the overgrowth of skin cells.
Some steroid creams that may be prescribed for psoriasis include:
- Ultra-high steroids, such as Clobek (clobetasol) 0.05% cream
- High-potency steroids, such as Ciclocort (amcinonide) 0.1% cream
- Steroids of moderate potency, such as Alphatrek (betamethasone dipropionate) 0.05% cream
The effectiveness of topical steroid creams increases with strength, as do side effects. Side effects of prescription steroids include worsening acne, itching, stretch marks, thinning of the skin, and red or purple patches on the skin.
Apply steroid creams only to the affected areas and do not use them for more than three weeks without consulting a healthcare professional.
2. Keratolytics
Keratolytics are drugs that help remove excess skin. A prescription keratolytic cream can help slow down skin growth and remove scaly skin. Dermatologists may prescribe keratolytics to speed the shedding of thick, rough skin, repair damaged skin, and relieve itching.
These topical creams include Tazorac (tazarotene) and prescription salicylic acid, sold under brand names such as Salek and Keralit.
Tazarotene can cause burning, itching and reddening of the skin, especially when used in high concentrations. To reduce the risk of side effects, your dermatologist may recommend using a cream with a lower strength, combining it with a moisturizer or applying it every other day.
Prescription salicylic acid also has a penetrating ability that helps other psoriasis creams work better. Some side effects of salicylic cream include toothache, headache, dizziness, hearing problems, and vomiting.
3. Calcineurin inhibitors
The FDA has approved calcineurin inhibitors such as Protopic (tacrolimus) and Elidel (pimecrolimus) for the treatment of dermatitis (eczema). Dermatologists may also prescribe these creams off-label—meaning for a purpose other than the one they’re approved for—to treat psoriasis symptoms.
Protopic and Elidel creams suppress the immune system and reduce inflammation by blocking calcineurin, a protein that contributes to inflammation. Dermatologists more often prescribe these drugs for the treatment of psoriasis of the face and genital organs.
You can safely apply calcineurin inhibitors to the affected areas twice a day and see results within 1-4 weeks of application. See your doctor if you don’t see an effect after four weeks or if your symptoms get worse.
Side effects include burning, stinging, and worsening itching, but these effects often improve with continued use. The FDA also warns of a possible cancer risk with these drugs, although this is based on animal studies and has not been seen by dermatologists.
4. Vitamin D analogues
Vitamin D analogs, such as Dovonex (calcipotriene) and Vectical (calcitriol), treat mild to moderate psoriasis in people over 18 years of age.
These creams slow the growth of rapidly dividing cells and aid skin repair by increasing cell differentiation. Dermatologists may prescribe vitamin D analogs to flatten thick psoriasis and remove scales. The cream is usually applied twice a day, around the same time.
Vitamin D analogs are generally safe, but some people experience side effects such as burning, peeling, itching, and dryness.
5. Zorive (Roflumilast) cream
Zorive is a cream version of the drug roflumilast. It is approved for the treatment of psoriasis in people 6 years of age and older. It works by blocking a molecule called phosphodiesterase-4 (PDE4), which plays a role in inflammation.
Zorive is steroid-free and can treat psoriasis on sensitive areas (eg face) and where the skin folds (eg underarms, buttocks, under breasts).
This cream is usually applied once a day to the affected areas to reduce itching. Side effects include diarrhea, headache and increased blood pressure.
6. Vtama (Tapinarof)
Vtama is a cream that is approved for the treatment of plaque psoriasis. It is applied to the affected area once a day in a thin layer.
Vtama acts as an aryl hydrocarbon receptor (AHR) agonist. It sticks to and activates AHR, a protein that regulates the immune response. When the AHR is activated, your inflammatory response is reduced. Vtama is the first drug of its kind to be approved for plaque psoriasis.
Vtama can also regulate filaggrin and loricin, two proteins that protect the skin barrier.
Common side effects include inflamed hair follicles (folliculitis) and the common cold. Headache can also be a side effect. Another potential side effect of Vtama is irritant contact dermatitis – when the skin becomes red, sore or inflamed after direct contact with an irritant.
Avoid using products containing the following ingredients if you have psoriasis, as they can irritate your skin or lead to inflammation:
- Alcohol: Creams that contain alcohol can dry out your skin, making the itching worse.
- Smell: For some people, scented products can further irritate the skin.
- Sulfates: Look for sulfate-free products, as creams containing sulfates can irritate the skin.
If you have used psoriasis creams without any reduction in the severity of your symptoms, or if the affected area is too large to use creams, see your doctor for alternative treatments.
Depending on the severity of your case, dermatologists may recommend an oral medication used alone or with topical creams. Some prescription oral medications to treat psoriasis include Rheumatrek (methotrexate), Otezla (apremilast), Soriatane (acitretin), and Sotikta (deucravacitinib).
Your doctor may also recommend biologics such as Remicade (infliximab), Humira (adalimumab), Cosentik (secukinumab), and Tremfia (guselkumab) for more severe cases of psoriasis.
Another option is ultraviolet B (UVB), also known as narrow-band phototherapy. This treatment is usually prescribed to children, pregnant or lactating women, or people with a weakened immune system.
There is no cure for psoriasis, but treatments can help manage symptoms such as itching, redness, and scaly skin. Topical creams are a common first-line treatment for psoriasis.
Psoriasis creams come OTC and by prescription. While OTC creams can be effective for mild cases, prescription options may be necessary for moderate to severe psoriasis.
The type of psoriasis cream that is best for you depends on a variety of factors, including the severity, location and type of psoriasis, as well as your response to previous treatments and personal preferences. Your healthcare provider can help you determine the most appropriate treatment plan.