OTC Treatment for Psoriasis

Moisturizers help control scaling and dryness and may improve associated itching. They should be applied immediately after bathing and at other times during the day. Moisturizers should be applied in the direction of the hairs to minimize the risk of “pimple-like” eruptions.

Vaseline, Eucerin and Aquaphor are all occlusive sticky products that can be of benefit.

Tars:

Tars are available as shampoos, soaps, gels, lotions, creams, ointments and bath oils. Coal tar has been used since at least the beginning of the last century. These products can be combined with topical corticosteroids. These products make the skin sensitive to ultra violet-A light waves (UVA). They are often used in combination with ultra violet-B light waves (UVB). Folliculitis can be a side effect.

Tar shampoos are commonly used to treat scalp psoriasis, however they may discolor white hair, turning it a yellowish color. They also tend to have an unpleasant odor.

Salicylic acid:

Salicylic acid moisturizers and shampoos help remove some of the scales seen in psoriasis. It may be useful in reducing the thickness of psoriatic scale but care must be taken to be gentle to the skin to prevent flaring of the psoriasis. It may be combined with tar, anthralin and topical corticosteroids. Salicylic acid inactivates Calcipitriol.

If applied to large area, too much of this drug can be absorbed producing toxic effects from high blood levels of salicylic acid, for example when using 2-10% Salicylic acid in petrolatum.

Other shampoos:

There are many over-the-counter “dandruff” shampoos which can improve scalp psoriasis, particularly the scaling. They include the tar and salicylic acid shampoos listed above, ketoconazole and zinc pyrithione.

Hydrocortisone cream:

Hydrocortisone cream may improve psoriasis on the face and in the skin folds and improve itching. A stronger prescription topical corticosteroid is usually required to improve psoriasis lesions elsewhere.

Anthralin (Dithranol):

This is derived from chrysarobin from the bark of the Araroba tree. Anthralin is available as a cream, ointment and scalp lotion. Lower concentrations can be left on overnight, while stronger ones (1% or higher) should be left on for 15-30 minutes. It is used to treat plaque and guttate psoriasis. Short contact with a high concentration works better than longer contact with a low concentration. Anthralin slows down the growth of the skin cells and has anti-inflammatory actions. Anthralin can cause staining (purple/brown color) of your clothes, skin, and hair, which limits its use. Irritation may also occur, but this can be minimized by applying the anthralin only to the psoriasis patches and avoiding uninvolved skin. You should not use Anthralin on the face, genitals or in the skin folds.

A product developed in Sweden called Micanolâ is designed for short contact use. The anthralin does not stain if it is washed off with cool water.

Dovobet®

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INTRODUCTION
Dovobet (50 micrograms/gram calcipotriol and 0.5 milligrams/gram betamethasone dipropionate) is a topical ointment approved for use in Canada to treat plaque psoriasis. Dovobet has become the topical therapy of choice for many patients with plaque type psoriasis not involving the face or skin folds... | Read more ...

CLININCAL EXPERIENCE
More than six international studies involving over 6,000 patients have shown reductions in the PASI (Psoriasis Area and Severity Index) of approximately 40% after one week of treatment and 70% after four weeks... | Read more ...

INDICATIONS
Used to treat chronic plaque psoriasis that covers less than 30% of the body surface (see following slides for clarification). Dovobet is not often used to treat the scalp because the sticky base does not allow for easy application or removal... | Read more ...

PATIENT PROFILE
Patients with chronic plaque psoriasis that covers less than 30% of the body surface. In some cases, a patient could use it on a greater BSA if he/she wanted to as long as the use/week is 100 g per week or less... | Read more ...

DOSING
Dovobet should be applied to the affected area once daily for four weeks. Several studies have shown that there are no statistically significant differences between applying the ointment once daily or twice daily... | Read more ...

EFFICACY
Six international studies involving more than 6,000 patients using Dovobet to treat psoriasis have shown PASI reductions of approximately 40% after one week of treatment and 70% after four weeks. Additional studies have shown that Dovobet has superior... | Read more ...

COMPLIANCE
Compliance is aided by the convenience of the once daily dosing of Dovobet. Compliance is also less of a problem than with most products due to the rapid onset of action. Significant improvement is usually seen within the first week... | Read more ...

SIDE EFFECTS, SAFETY AND RISKS
Because Dovobet is a combination drug, the frequency of side effects reported is less than would be expected if using each compound on its own: for example, the anti-inflammatory action of the corticosteroid (betamethasone dipropionate) minimizes the irritation often reported when using calcipotriol alone... | Read more ...

COST OF TREATMENT
It is probably the single most effective topical therapy available for psoriasis, so patients are generally prepared to pay for this. It is somewhat more expensive than the equivalent potent topical steroid, but the rapid and significant improvement in quality of life... | Read more ...