Emollients
Bath solutions and moisturizers help soothe affected skin and reduce the dryness which accompanies the build-up of skin on psoriatic plaques. Medicated creams and ointments applied directly to psoriatic plaques can help reduce inflammation, remove built-up scale, reduce skin turn over, clear affected skin of plaques and may have an anti proliferative effect . they are particularly useful inn inflammatory psoriasis and plaque psoriasis of palms and soles, in which irritant factor can perpetuate the condition .
They hydrate stratum corneum , minimize evaporation of water, have mild antipruritic activity and mild vasoconstrictor activity. Applied three to four times daily . twenty minutes in bath prior to application is beneficial. Note that Some emollient preparations may have a photoprotective effect, and if applied immediately before UVA irradiation could interfere with the efficacy of PUVA therapy.
salicylic ( gels ,creams and ointments ) and lactic acids are used to remove the scales , keratolytic , smooth the skin and remove hyperkeratosis which can be used alone ( no study documented as monotherapy ) or with corticosteroids .Applied two to three times . but may enhance penetration of some drugs and don't use prior to phototherapy .
Coal tar (DHS Tar, Doak Tar, Theraplex T) contains literally thousands of different substances that are extracted from the coal carbonization process.
Anti mitotic action antiscaling properties applied for steroid resistant patients , large area can be involved ,widespread small lesions and may be in case of oral agents are contraindicated due to systemic illness Crude coal tar (coal tar, BP) is the most effective form, typically in a concentration of 1 to 10% in a soft paraffin base, but few outpatients tolerate the smell and mess. Cleaner extracts of coal tar included in proprietary preparations, are more practicable for home use but they are less effective and improvement takes longer.
Make resolution of mild moderate plaques , can used in combination with UVB (Goekermann’s regimen) to increase treatment response and tar creams are useful for psoriasis of the scalp ( used overnight ). The disadvantages of this therapy un pleasant odour , stains skin and clothing , photosensitivity and carcinogenicity irritation, contact allergy,and sterile folliculitis can occur. The milder tar extracts can be used on the face and flexures. Tar baths and tar shampoos are also helpful. You must have caution with eyes, mucosa, genital or rectal areas, and broken or inflamed skin; use suitable chemical protection gloves for extemporaneous preparation .
Dosage started from low concentration then titrated to higher one and applied once daily may be combined with Calamine (Calamine and Coal Tar Ointment, BP ) , Salicylic Acid ( Coal Tar and Salicylic Acid Ointment, BP ) , Zinc (Zinc and Coal Tar Paste, BP ) . ( ointments , creams, pastes, gels, oil, solution and shampoo ) applied for 1 to 3 times daily .
Anthralin (Dithranol, Anthra-Derm, Drithocreme) is a synthetic form of a tree bark extract inhibits DNA synthesis yielding an ant proliferative effect , effective for widespread psoriatic plaques and can be used alone or in combination with UVB, topical steroids , salicylic acids and coal tar ( may help to reduce the irritant effects of dithranol without affecting efficacy ) unlike coal tar, is irritant to healthy skin and care is required to ensure that it is only applied to lesions and applied once daily ointment ,cream ( less effective but are more suitable for domestic use. ) , gel ( for scalp ) and paste such as Lassar’s paste to minimise spreading to perilesional skin is left on overnight covered with a suitable dressing and washed off the next day.
Anthralin stains clothing or linens purple or brown. Use with caution if the individual has kidney disease. Care must be taken to apply this medication only to psoriasis patches and not to surrounding normal skin. Anthralin may cause skin discoloration (increased pigment) and may burn or irritate skin. Do not use on the face, neck, skin folds (back of knees or elbows), or genitals. Avoid contact with the eyes. Do not use on excessively irritated patches. This medication should only be used if the patient can comply with instructions for use and it's contraindicated with hypersensitivity; acute and pustular psoriasis
Anthralin Cream
Anthralin Side Effects
Tazarotene (Tazorac) is a topical retinoid that is available as a gel or cream. This medicine is sometimes combined with corticosteroids to decrease skin irritation when used alone and to increase effectiveness. Tazarotene is particularly useful for psoriasis of the scalp.
The mechanism not well defined through it affects cell differentiation , proliferation and inflammation . Effective in mild-moderate psoriasis especially with corticosteroids . Applied once daily at night ( 0.05, 0.1 gel ) up to 12 weeks; child under 18 years not recommended
Caution must be taken with person who have Allergy to retinoids and mother who is pregnant ( category X ) or breastfeeding . Peeling, burning, stinging, dryness, erythema and puritis . Cosmetics or soap products that dry or irritate the skin may worsen the irritation and dry skin when used with a topical retinoid. Do not use on open wounds or sunburned skin. This medicine may cause burning or stinging. Sensitivity to the sun may occur. If skin irritation or pain increase, contact a doctor . wash hands immediately after use, avoid contact with eyes face, intertriginous areas, haircovered scalp, eczematous or inflamed skin; avoid excessive exposure to UV light (including sunlight, solariums, PUVA or UVB treatment)
tazarotene topical
Tazarotene topical Pregnancy and Breastfeeding Warnings
Tazarotene Side Effects
Vitamin D and analogues Calcipotriol, calcitriol, and tacalcitol are used for the management of plaque psoriasis as cream, ointment and solution for scalp psoriasis inhibit keratinocyte differentiation and proliferation and have antiinflammatory effects by reducing IL-8, IL-2, and other cytokines. Use of vitamin D itself is limited by its propensity to cause hypercalcemia. Unlike corticosteroids, tachyphylaxis does not occur with prolonged use. Clearance of lesions should occur after 4 to 6 weeks of treatment Lack of response by 8 weeks indicates treatment failure Topical calcitriol has been studied for treatment of psoriasis and appears almost as effective as betamethasone dipropionate in clearance of lesions, with a longer remission period It is less irritating than calcipotriol and can be used for the face and flexures. Calcipotriol plus betamethasone is available as a combination product In contrast, salicylic acid can completely inactivate calcipotriol on contact.
the concentration of calcipotriol used is 0.005%. Applications should be made once or twice daily. Combination therapy may also reduce the cumulative dose of acitretin, UVB, or PUVA required to achieve clearance or marked improvement of psoriasis, potentially reducing the risk of long-term adverse effects from these treatments However, because of the potential for the vehicle of topical calcipotriol preparations to block UV irradiation, they should be applied at least 2 hours before irradiation. Tacalcitol may be degraded by UV radiation and therefore if combined with UV therapy, the radiation should be given in the morning and tacalcitol applied at bedtime.
They should be avoided by those with calcium metabolism disorders, and used with caution in generalised pustular or erythrodermic exfoliative psoriasis (enhanced risk of hypercalcaemia). Local skin reactions (itching, erythema, burning, paraesthesia, dermatitis) are common. Hands should be washed thoroughly after application to avoid inadvertent transfer to other body areas. Aggravation of psoriasis has also been reported. BNF also suggests that may avoided in case of pregnancy if possible and liver disease and used in restricted amounts. Monitoring urine and plasma concentration .
Vitamin D
Vitamin D3
Topical steroids are available as ointments, creams, lotions including scalp lotions, and a few foam products, and should be applied in a thin layer on the skin. Ointments are the most effective formulations for psoriasis because they have an occlusive oily phase that conveys a hydrating effect and enhances penetration of the corticosteroid into the dermis. They are not suited for use in the axilla, groin, or other intertriginous areas where maceration and folliculitis may develop secondary to the occlusive effect. Creams are more cosmetically desirable for some patients. They may be used in intertriginous areas even though their lower oil content makes them more drying than ointments.
Anti inflammatory, antimitotic and antipruritic properties . They're most frequently used topically with psoriasis lowering the amounts of arachidonic acid, prostaglandins, and leukotrienes in the skin. These effects, coupled with local vasoconstriction, reduce erythema, pruritus, and scaling, adjunct to other forms of topical therapy and monotherapy only if isolated plaque(s) or small area
For mild to moderate psoriasis, mid-potency corticosteroids such as betamethasone valerate (0.05% to 1%) are most frequently selected first, with escalation to higher-potency corticosteroids if needed, and stepping down to lower-potency corticosteroids when the psoriasis improves.High-potency corticosteroids may be used initially in thicker plaque areas such as palms and soles, but should be considered for short-term use only. These include fluocinonide, clobetasol, halobetasol, and betamethasone dipropionate in optimized base.
Low-potency corticosteroids such as hydrocortisone (0.5% to 2%) are appropriate choices if treatment of the face or flexures is necessary Intralesional triamcinolone may be useful for specific lesions such as nail matrix psoriasis. It's reported that Using a potent corticosteroid for only 1 to 2 days per week (“weekend therapy”) has been shown to lengthen the duration of effectiveness. Combining this regimen with calcipotriol used during the week may provide greater efficacy.
It is important to remember that adverse effects of topical corticosteroids may be systemic in nature and hypothalamic-pituitary- adrenal axis suppression can occur, especially when high-potency corticosteroids are used. Tachyphylaxis due to down-regulation of steroid receptors can occur with prolonged use, making the treatment regimen ineffective Infants and small children may be more susceptible due to their increased skin surface: body mass ratio. Topical corticosteroids may also cause striae, skin atrophy, acne, telangiectasias, and rosacea. Atrophy can result in thin, fragile, easily lacerated skin. Striae are caused by tearing of dermal connective tissue and are irreversible. Due to their significant adverse-effect profile, it has been recommended that no topical corticosteroid be used regularly for more than 4 weeks without review and reassessment.
fluocinonide topical Consumer Information (Cerner Multum)
fluocinonide topical Consumer Information (Cerner Multum)
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