First Line Treatments for Psoriasis

These are the initial treatments your doctor or nurse may suggest to manage your psoriasis. For people with mild to moderate plaque psoriasis they may well be all that is needed. If your psoriasis is severe or does not respond to these treatments you may be referred to a Dermatologist for second line treatments.

First line treatments usually involve applying creams and ointments to the skin (‘topical treatment’) and when used properly they have minimum side effects. Whatever treatment you use remember that keeping the skin well moisturised is extremely important.

Vitamin D derivatives – for example Calcipotriol (Dovonex), Talcalcitol (Curatoderm) and Calcitriol (Silkis) are widely prescribed. They are relatively easy to apply but you must expect improvement to be gradual, achieving maximum effect over up to 12 weeks of treatment. If used correctly you may achieve at least flattening and partial clearance of psoriasis plaques. The vitamin D treatments act by promoting normal skin cell growth and development and preventing the excessive growth rate of cells. They are not steroids and can therefore be safer for longer-term use – they are also non-staining and more cosmetically acceptable. Overuse, however, can interfere with the body’s absorption of calcium. Dovonex should not be used on the face, but Curatoderm and Silkis can be used safely on the face. The vitamin D derivatives are only available on prescription.

Tar preparations - Refined tar preparations are less smelly and messy than old unrefined products. Creams and lotions such as Exorex are available from your pharmacy or GP. Exorex was originally a herbal over-the-counter product that is now available on prescription; however, a prescription is not required for some of the products in the range. It contains some coal tar and has fatty acids similar to those found in banana skin. Other tar-based products are available. Tar based preparations may stain clothes or irritate the skin and can be a little messy. Response times can be slow – improvement usually takes 6 to 12 weeks. Treatment should be applied away from flexural areas twice daily.

Dithranol preparations - are used to treat well-defined plaques of psoriasis and need to be applied carefully to avoid irritating non-affected skin. It is used as ‘short contact therapy’ away from the face, flexures and genitals. You should always start with the lowest strength and apply the ointment to the plaques for 15 to 30 minutes a day and then wash it off. Increased strengths can be introduced weekly unless an irritation occurs. Dithranol takes longer than steroids to work, in many cases up to six weeks of treatment is required for an improvement to be seen. Despite it being a time consuming treatment, dithranol can be very effective if used properly - but you need to be well motivated to carry it out.

Vitamin A derivatives – for example Tazarotene (Zorac) are applied once daily having put Vaseline onto the plaques and surrounding skin one hour before applying the treatment. This reduces the chance of an irritation occurring. They may be used for up to 12 weeks. They are designed for treating mild to moderate psoriasis.

Topical steroids – for example Alphosyl HC cream / Eumovate / Betnovate / Dovobet / Halciderm. Topical steroids are one of the first treatment options for people whose psoriasis covers 5% or less of their body. They are easy to apply and can have dramatic, positive results. However, steroid based creams must not be used for too long a period of time and always by your doctors instructions, as psoriasis can return as bad or worse if used for too long or in too greater quantities. Short-term use of steroid creams can be very helpful when psoriasis is inflamed or when it exists in delicate parts of the body. Low potency steroid creams can be used on the face or in the skin folds. Dovobet is a combination of a steroid and a vitamin D derivative and is indicated for mild to moderate plaque psoriasis.

This is a basic introduction to the kind of treatments you may be prescribed when you first see your doctor and it refers largely to mild to moderate plaque psoriasis. Should you require any further information regarding a specific treatment, please do not hesitate to contact us. If you have any concerns about the treatment prescribed do discuss this with your doctor. If you are buying products over the counter discuss them with the pharmacist and always read the label to make sure you are using them correctly.