The good news about psoriasis is that there’s a wide variety of treatments available to treat all severities and areas of the body.
Everyone’s psoriasis acts in a unique way, meaning it can be a process of trial and error to find a treatment or combination of treatments that work best for you. This can be really annoying, but try to persevere. Topicals are where psoriasis treatment starts for the majority of patients, and many find that topical treatments are all they need to keep their psoriasis in check.
Topical treatments, unfortunately, don’t work overnight. Most of them can take a good few weeks to start making a difference, which can be frustrating and disheartening. It’s important to try and not get demotivated though, and keep using the topicals as directed for the length of prescription.
If topical treatments do not have a good enough effect on your psoriasis, you can go back to your doctor able to say that you gave it your best shot, and this then opens you up to other treatment options.
Download the Psoriasis Association's Treatments from a GP leaflet for more information on topical treatments.
Moisturisers and Emollients
Why Moisturise Psoriasis?
Regular moisturising is key to living with psoriasis on a day-to-day basis. This is because moisturising makes the skin much more comfortable; it reduces itching and soreness and, by making the skin less dry, can reduce scaling and flaking. So, a good regime can make you feel better and make your psoriasis look a bit better too. Moisturisers can also help active treatments to be absorbed more effectively, and so many doctors suggest that you moisturise around half an hour before applying treatments. This is the ideal, but we’re aware it can sometimes be hard to do.
What’s the difference between lotions, creams and ointments?
The difference between these three types of moisturiser is the consistency. Lotions are quite thin and runny, making them easy to apply and quickly absorbed. However, this means they’re not particularly good at moisturising skin that is very dry. Creams are a bit thicker and often come in a tube or pump dispenser. Ointments are very thick and - as they are oil based - quite greasy. These are best at moisturising skin that is very dry, although some people don’t like them much as they are sticky and take a while to sink in.
Which should I use?
It really is a personal choice, and you must find a balance between the best moisturiser for your skin, and being able to go about your day-to-day life. It wouldn’t be very good for your skin to just use a lotion all the time, as it wouldn’t be moisturising enough. Your skin would be really well moisturised if you used an ointment all the time, but you wouldn’t much like looking and feeling greasy all day!
Many people find that a combination of the three is best. You might want to put a cream or lotion on first thing in the morning, so that you don’t feel greasy all day, and then switch to a thicker ointment before bed, so it moisturises all night. You could also carry a small pot of cream in your bag during the day, so you can top up your moisturiser if your skin starts to feel sore.
Different parts of the body require different levels of moisture. So, skin that touches other skin, such as your armpits or between your bum cheeks might be OK with a lotion, whereas hands and feet probably need a thicker cream or ointment.
TOP TIP: Try putting on cotton socks or gloves after you’ve moisturised and are just sitting watching telly - it helps the moisturiser to sink in. Even beauticians recommend this, so your friends without psoriasis might be interested in giving it a try too! You can get spa gloves and socks from places like Boots or the Body Shop.
Applications are usually made up of crude coal tar, mixed in a paraffin base. It comes in different strengths, of typically 1-10% coal tar.
Coal tar is quite good at reducing scaling and inflammation, but can be messy and a bit smelly. It has been used to treat psoriasis for hundreds of years, but has gone out of fashion recently with the coming of newer, cleaner and more pleasant treatments.
Still, if your doctor recommends you try a coal tar treatment, it’s certainly worth giving it a go, as it may help to clear your psoriasis up. Coal tar treatments are available in body and scalp applications, shampoos and body washes.
These are one of the first treatments many doctors prescribe to people with small amounts of psoriasis. They tend to come as a cream, and are described as having different ‘potencies’. ‘Very potent’ is the strongest, and ‘mild’ is the weakest.
People can be wary of using steroids, as they hear that they can be damaging to the skin if used for too long. Whilst it’s true that you shouldn’t use them for too long, you should rest assured that your doctor will be reviewing your treatment every four to six weeks, and will use the lowest strength possible that makes a difference to your psoriasis.
When you do stop using a steroid cream, it’s better to slowly reduce how often you use it (e.g. go from once a day to once every two days, to once every four days, and so on), rather than to just stop using it altogether. This is because abruptly stopping a course of steroids can sometimes lead to a rebound of psoriasis.
Dithranol is often used to treat large, well-defined areas of psoriasis.
It has to be applied directly to the psoriatic plaque, and shouldn’t be allowed to touch the surrounding normal skin, as it can cause irritation and staining. Because of this, it wouldn’t be a suitable method of treating lots of very small areas, such as with guttate psoriasis.
Dithranol preparations come in ointments or creams of different strengths, sometimes shown by a different colour packet. Depending on which formulation you’re given, you may have to leave it on your skin for anywhere between 10 and 30 minutes.
Although Dithranol can be a really effective treatment, the fact is that it is time consuming and messy. There are ways of fitting it in though. Try to do other things whilst the Dithranol is working on your skin; chores, homework, brush your teeth, or catch up with your favourite TV show!
These treatments encourage skin cells to grow and develop normally, rather than the speedy over-growth we see in psoriasis.
They’re not thick or sticky or smelly, don’t stain, and are safe for longer-term use than steroids. Your doctor should still continue to see you regularly, however, as overuse can interfere with how the body absorbs calcium.
Vitamin D treatments come as ointments, lotions or scalp applications, and there are suitable applications for any area of the body. There are also formulations that are mixed with a steroid, although with these you have to be careful how much of the treatment you use, and how large an area of the body it is applied to.
For further information about psoriasis, or for a list of resources used in the production of this information resource, please contact the Psoriasis Association. December 2017 (Review: Dec 2020).