Over-the-Counter Topicals

Salicylic acid is classified as a keratolytic, or peeling agent. It works by causing the outer layer of skin to shed. It is a common and effective treatment for a wide variety of skin problems. As a psoriasis treatment, it acts as a scale lifter, helping to soften and remove psoriasis scales.

Strong salicylic acid preparations can cause irritation if left on the skin for too long. Further, the body may absorb too much salicylic acid if used over large areas of the skin. Salicylic acid may also weaken hair shafts and make them more likely to break, leading to temporary hair loss. Please consult your health care professional if you experience any complications.

Tar derived from coal and wood (e.g., juniper and pine) is used for medicinal purposes. However, coal tar is most commonly used to treat psoriasis. Tar can help slow the rapid growth of skin cells and restore the skin’s smooth appearance. In addition, it can help reduce the inflammation, itching, and scaling of psoriasis. Tar products can vary dramatically from brand to brand. Generally, the higher the concentration of tar, the more potent the product.

Tar can irritate, redden and dry the skin. You should test a tar product on a small area of the skin first. If reddening occurs, try applying the tar on top of a moisturizer. Tar can stain clothing, bed linen, and light-colored hair. Tar can also make skin more sensitive to sunlight, so be sure to wash it off thoroughly, use sunscreen, and monitor your sun exposure. Tar remains active on the skin for at least 24 hours, so limit your time outdoors as you will be at an increased risk of sunburn during this period.

Studies show some of the chemicals in coal tar may cause cancer, but only in very high concentrations, such as in what is used in industrial paving. If you are using tar regularly, make sure to follow a regular skin cancer checkup schedule.

California requires OTC coal tar shampoos, lotions, and creams that contain more than 0.5 percent coal tar to be labeled with cancer warnings. However, the FDA maintains that OTC products with coal tar concentrations between 0.5 percent and 5 percent are safe and effective for psoriasis, and there is no scientific evidence that the tar in OTC products is carcinogenic.

Keeping the skin moisturized daily is an important part of psoriasis care because it reduces redness and itching and helps the skin heal. Dermatologists recommend heavy creams and ointments that lock water into the skin. Cooking oils and even shortening can be effective as economical substitutes for commercial moisturizers. Here are some quick tips for keeping your skin moisturized:

• Use fragrance-free products
• Apply moisturizers after showering and after washing your hands
• Wash with moisturizing soaps
• Limit lukewarm showers to 10 minutes or less

Bath solutions can be beneficial in treating psoriasis. Adding oil, oatmeal, Epsom salts, or Dead Sea salts in a bath has been effective for some when it comes to removing psoriasis scales and soothing itch. Soak for around 15 minutes and apply a moisturizer or oil to the skin immediately after getting out of the bath.

Scale lifters help loosen and remove scale, allowing medications to reach the psoriasis plaques. There are scale-lifting products designed for the scalp and body. Note that scalp products are usually stronger and may be too harsh for other skin sites. OTC products that contain an active ingredient of salicylic acid, lactic acid, urea, or phenol can be used as scale lifters.

Some topical medications or moisturizers can be occluded (or covered) to increase their effectiveness and the amount absorbed into the skin. With occlusion, the topical is applied to psoriasis plaques, and the area is covered with plastic wrap, cellophane, waterproof dressing, cotton socks, or a nylon suit. Always check with your health care provider before occluding any treatments.

There are several ingredients that have been approved by the FDA for treating itch. Some of these include calamine, hydrocortisone, camphor, diphenhydramine hydrochloride (HCl), benzocaine, and menthol. Be aware that these ingredients may increase irritation and dryness.

Ingredients such as aloe vera, jojoba, zinc pyrithione, capsaicin, and others are frequently used to moisturize, soothe, remove scale or relieve itching for people with psoriasis.

The effectiveness of these products varies by individual, and many have not been medically evaluated for the specific treatment of psoriasis. Be aware that “natural” ingredients can also cause side effects or allergic reactions. If irritation occurs, discontinue use.

Inverse psoriasis can be treated with Castederm, a liquid that is painted on the affected skin to help dry moist plaques of psoriasis in the folds of the body. The use of powders may also help to dry the moist plaques associated with inverse psoriasis.