Treating psoriasis: It's all about timing

When you start a new psoriasis treatment, one of the first things on your mind may be "When will it start to work?" You may also want to know how long you should continue to use the medication. The answers vary, depending on which topical medication you are using.

Calcipotriol starts to work after about 2 weeks. Maximum effects are seen after 6-8 weeks of treatment. The medication can be stopped once the psoriasis clears up. Sometimes, the psoriasis may return, in which case the medication can be started again. Calcipotriol is also available as a combination product with betamethasone. This combination medication works more quickly, with major improvements after one week and maximum effects in four weeks. Calcitriol is another psoriasis medication that is in the same class as calcipotriol.

Corticosteroids (also known as "steroids") come in different strengths, ranging from mild to very strong. Commonly used corticosteroids include hydrocortisone, betamethasone, amcinonide, and mometasone. They can also be used with air-tight dressings to increase their effects. The strength of the steroid and whether an air-tight dressing is used can affect how quickly the medication starts to work. When a strong steroid is used in combination with an air-tight dressing, it may be able to clear up psoriasis in one week. Corticosteroids can cause side effects (such as high blood pressure, unusual hair growth, loss of blood sugar control, muscle cramps, and weight changes) if they are absorbed into the body. This is more likely to happen if strong steroids are used with air-tight dressings, if a large body area is treated, or if treatment continues for a long time. Check with your doctor or pharmacist about how long you should continue to use corticosteroids.

Salicylic acid is often used in combination with other medications because it softens up psoriasis scales, allowing the other medications to reach the skin more effectively. Occasionally, your physician may ask your pharmacist to mix salicylic acid into a commercial preparation for added effect. Some products contain both salicylic acid and a topical steroid (e.g. betamethasone). If used for long periods of time, on large body areas, or under airtight dressings, salicylic acid could be absorbed into the body, leading to side effects such as ringing in the ears, nausea and vomiting, or confusion.

Tazarotene begins to work after one week of treatment. Symptoms usually continue to improve throughout treatment. Treatment is usually given for 12 weeks, and most people will have seen an improvement after 12 weeks of treatment. Some people continue to show an improvement for up to 12 weeks after the treatment is stopped. Tazarotene may be combined with other ingredients like topical steroids in certain products.

Anthralin clears up psoriasis in about 3 weeks. It has been shown to have few long-term side effects, so it may be safely used for longer periods of time.

Coal tar can clear up psoriasis in 3-4 weeks. If you use coal tar, your doctor may recommend that, every now and then, you take a break from using it.

Talk to your doctor or pharmacist about how long you should continue to use your topical psoriasis medication.

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