All you need to know about the variety of topical (local) treatments for psoriasis skin disease.

Psoriasis is a chronic inflammatory skin disease characterized by the fact that the skin cells (keratinocytes), under impaired immune control, divide at an extremely rapid rate. The main characteristic of the disease is the formation of lesions on the surface of the skin, which may itch or hurt.

Today there is no cure for the disease, but there are a variety of treatments that can alleviate symptoms, significantly improve the quality of life of patients, and lead to a temporary reprieve of the disease. Treatments are divided into local treatments, treatments based on ultraviolet radiation, systemic treatments, and biological treatments. In this guide, we will concentrate on local (topical) treatments.

Local, or topical, treatments are designed for people with mild disease, people whose area of skin affected by the disease is not large, as a complement to other treatments, and for people who cannot get other treatments for health reasons.

One of the problems with topical treatments is that patients do not always persist in treatment and make sure to apply it as needed several times a day.
The local treatments fall into two main categories: steroid cream treatment and other non-steroids.

Steroid Treatments

Steroid cream treatment is the most common local treatment for psoriasis and includes a wide range of preparations. Steroids work on the disease in a number of mechanisms, the main one being inflammation reduction.

The great advantage of such treatments is that they are comfortable because they work very quickly and the side effects in the short term are minimal. The major disadvantage of these treatments is that they cannot be used over time because of side effects. Most side effects are local, but some sides effects may be systemic.
Local side effects include premature aging of the skin, sterility, stretch marks. Capillaries, and atrophy of the skin. The higher the potency of the preparation, the greater the risk of significant side effects. In delicate areas such as the face, there may be other side effects, such as acne and eye damage.

Systemic side effects include known side effects of steroids including diabetes, osteoporosis, cataracts, glaucoma, and psychiatric side effects. The side effects are dependent on the duration of use, the intensity of the steroids, the area of the skin treated, and the area treated i.e. folds of skin. The side effects are more significant when treating more subtle areas such as the folds of skin and the face.

Non-Steroidal Treatments

The main drawback of topical (local) non-steroidal treatments is that compared to steroid treatments, they work much more slowly. The advantage is that with most treatments the side effects are significantly less than the side effects associated with the use of steroids. There are several groups of non-steroidal treatments:

Grease

Psoriasis on dry skin is like wildfire. There are a variety of fatty substances to prevent dryness. These treatments are often not sufficient for treatment alone, but, in some cases, they can be an addition to other treatments. Fatty substances have no significant side effects, but they sometimes cause an unpleasant feeling of oily skin.

Salicylic Acid-Based Preparations

Salicylic acid-based preparations are mainly designed to reduce dandruff. The acid acts by breaking the keratin – a protein that creates the hard outer layers of the skin – and leads to peeling dead skin cells that have hardened. Not all salicylic acid-based treatments are ready-made – they need to be prepared, and this involves time. In addition, medications that are not ready may not be covered by health insurance so the treatments are relatively expensive. The higher the percentage of the active ingredient, the better the effect of peeling, but also the more expensive the product and the more irritated the skin. Apart from skin irritation, the overall body skin effects associated with treatment are rare – dizziness and bleeding – symptoms that may occur mainly in the use of large quantities and /or over large areas.

Ditrocker Preparations

Diatecram is an ancient substance use for psoriasis for many years. It originates in wood resin in Brazil, but the material used today is synthetic. The efficacy of the psoriasis drug was discovered by chance after a British doctor gave it to a psoriasis patient because he thought he was suffering from a fungus.
The benefit of diatrokram is that there are no limits on the duration of time used. The side effects of this product may be unpleasant, but they are not a health hazard. The substance can cause strong irritation if not used properly. In addition, the material gets very dirty – clothes will be stained no matter what you do, and if it touches healthy skin, it will create spots that will remain for a long time. Today the use of material outside the framework of a hospital is very limited.

Analogues of Vitamin D

Vitamin D analogues slow growth of skin cells. If you use the ingredients correctly, they have no side effects. Vitamin D is responsible for the calcium economy and if you over-express it, there may be an increase in calcium in the blood and skin irritation may also occur. The downside of these treatments is that they work slowly and begin to help only after about 4 weeks.

There are also combinations of steroids with vitamin D, which are also used until they are passed on to non-steroidal Vitamin D supplements.
Macrolides (Tacrolimus and Pimecrolimus)

Such immunosuppressive agents – similar to those of Vitamin D – work slowly, but are allowed for longer-term use. These are very expensive preparations that are especially suitable for delicate areas such as the face and groin and for those who do not want to use steroids over time. It is important to use a small amount of preparation otherwise it will cause irritation.

Tar
The use of tar has been known for about 100 years as an effective treatment for psoriasis. The tar has 40,000 chemical components, and it is unclear exactly how the preparations work. Today, tar-based preparations are used mainly in combination with phototherapy (in Goeckerman protocol), but also as a treatment itself, especially for a scalp mop.

By *Dr. Felix Pavlotzky is Director of the Psoriasis and Phototherapy Unit, Department of Skin at Sheba Medical Center in Tel Hashomer, Israel.

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