How topical psoriasis treatments work

What are topical treatments, and which ones are available in Canada?

Topical psoriasis treatments are creams, ointments, and lotions that are applied to the areas of the skin or scalp affected by psoriasis. They work only on the area where they are applied.

Topical psoriasis treatments available in Canada include:

  • Corticosteroids
  • Vitamin D3 analogues
  • Calcineurin inhibitors
  • Tazarotene
  • Emollients
  • Salicylic acid
  • Coal tar
  • Anthralin

How do topical treatments fit into psoriasis treatment? When are they used?

Topical treatments are usually used for mild-to-moderate psoriasis and are often the first type of treatment that is tried. They may be used alone or in combination with other treatments, and if they are not effective, your doctor has other choices, such as medicines that are swallowed or injected (systemic medications) or another option known as light therapy. In contrast to topical treatments, which work directly at the area where they are applied, systemic medications are absorbed into the bloodstream and work internally in the body. Systemic medications include biologics (such as adalimumab, infliximab and etanercept) and non-biologics (such as acitretin, cyclosporine, and methotrexate).

How do topical treatments work?

The cause of psoriasis is not completely understood, but it's believed that T cells, a part of the immune system, become over-stimulated and force your skin cells to grow too quickly, interfering with the natural growth cycle of the skin. This leads to the red, scaly skin patches found on the scalps and bodies of people with psoriasis. Topical psoriasis treatments act on different parts of this process, depending on which one is used, but all work only on the area where they are applied.

Each topical medication has a slightly different action:

  • Corticosteroids work by reducing inflammation (skin redness and irritation) and slowing down skin cell growth.
  • Vitamin D3 analogues control abnormal skin cell growth.
  • Calcineurin inhibitors help control inflammation, itchiness or redness.
  • Tazarotene reduces inflammation and helps control skin cell growth.
  • Emollients reduce scaling.
  • Salicylic acid makes psoriasis scales softer and easier to remove. Once the scales are removed, other medications can reach the affected areas more effectively.
  • Coal tar slows down the growth of skin cells.
  • Anthralin helps control the growth of skin cells so they grow at a more normal rate.

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