There are many topical treatments available for psoriasis. Some, such as coal tar and anthralin, have been a mainstay of psoriasis treatment for over 100 years. Creams containing corticosteroids have been used for at least 50 years. Salicylic acid is newer than coal tar or anthralin, but is still among the older psoriasis treatments. Calcipotriol, calcipotriol plus betamethasone, and tazarotene are a few of the newer topical treatments for psoriasis.
Calcipotriol is a synthetic form of vitamin D. It works by helping to control the skin cell overgrowth that leads to symptoms of psoriasis. It is available as a cream, an ointment, and a scalp lotion. Betamethasone is a corticosteroid. It works by reducing the skin inflammation (redness, soreness) that accompanies psoriasis. It is available as a cream, an ointment, and a scalp lotion. The calcipotriol/betamethasone combination product is available as an ointment. Calcipotriol is applied twice daily to start, then reduced to once daily when the treatment has started to work. Calcipotriol/betamethasone is applied once daily to the affected areas.
Calcipotriol usually begins to work after 2 weeks of treatment, with maximum effects seen after 6-8 weeks of treatment. The combination product works more quickly. It takes about one week to show a major improvement, and maximum effects are seen in about 4 weeks. Once the psoriasis clears up, calcipotriol or calcipotriol/betamethasone can be stopped.
Most people can safely use calcipotriol and calcipotriol/betamethasone. But people who are allergic to the medications should not use them. Women who are pregnant or breast-feeding should check with their doctor, as it is not known whether these medications are safe in these situations.
The most common side effect of calcipotriol is skin irritation. This may be less likely with the combination product. Allergic reactions can also occur. If very large areas of the body (especially those with broken skin) are treated, blood calcium levels may increase. Depending on your situation, the doctor may use regular blood tests to make sure your calcium stays at a safe level.
Tazarotene is part of a group of medications called retinoids. It is related to vitamin A. It is believed to work by controlling skin cell overgrowth and decreasing inflammation.
Tazarotene comes as a cream and a gel and is applied once daily. It starts to work in about a week, and most people see some improvement in their symptoms after 12 weeks of treatment. Treatment can be stopped after the psoriasis clears up.
Tazarotene should not be used during pregnancy, as it can cause birth defects. It should not be used by people who are allergic to tazarotene or who have a skin condition known as seborrheic dermatitis. It is not known whether tazarotene is safe during breast-feeding. Tazarotene can increase a person's sensitivity to the sun, so sunscreen and protective clothing are needed. The most common side effects of tazarotene are skin itching, redness, burning, and irritation. Less often, tazarotene may cause skin pain, skin peeling, rash, dry skin, stinging, and high blood levels of a certain type of fat called triglycerides.
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