Creams for Psoriasis Relief

Q2. I have been using two topical therapies. One is called triamcinolone acetonide cream USP, 0.1 percent, and the other is halobetasol propionate ointment 0.05 percent. I’ve used them alternately for several years, depending on the severity of the flare-up (triamcinolone for dry scale and itching and halobetasol for oozing lesions). I was recently told that overuse of either of these could cause severe damage to internal organs – up to death. Well, that certainly got my attention. Please tell me it ain't so. Together these work very well to control my psoriasis.

It isn’t necessarily so. There are many side effects that can be attributed to topical “cortisones” like triamcinolone and halobetasol – especially when they’re used inappropriately – though death is a bit extreme.

Topical medications like yours are the cornerstone of psoriasis therapy and have been used safely, even over long periods of time. However, there is evidence that even short-term use of medications much less strong than the ones you have can lead to suppression of the adrenal glands for some patients. The adrenal glands are responsible for making several hormones that control water, salt and sugar balance in the body, and even some sex hormones. For a majority of patients, standard use is not likely to lead to significant hormonal problems.

I suggest that you make sure to have regular follow-up with your dermatologist, who can help to make sure that you are not using excessive amounts of topical medications.

Q3. Can I use Protopic to treat my husband’s scalp psoriasis? It worked wonders on my kid’s eczema.

Tacrolimus (or Protopic) is indicated for the treatment of atopic dermatitis (or eczema). It is not effective for psoriasis and is not FDA-approved for psoriatic treatment.

Q4. Does vitamin D cream help psoriasis?

Yes, vitamin D cream derivatives such as calcipotriene (Dovonex) do help psoriasis. Vitamin D is involved in the normal maturation of the skin. Psoriasis skin tends to be hyperproliferative in that the skin cells regenerate at a rate faster than normal. Thus, there is an accumulation of white flakes (or scale) and thickening of skin (or psoriatic plaques). Vitamin D creams help regulate this response and return maturation to normal.

Q5. Help! I have psoriasis and multiple sclerosis. I use Diprolene (betamethasone) for my psoriasis, but my dermatologist wants me to stop using it on my face. He says it thins my skin. I have many little patches all over my body. I live in North Carolina, and it’s quite hot. Any ointment or cream makes my skin hot and sticky. What do you suggest I do?

The issue of multiple sclerosis is important in that several of the newer medications for psoriasis (called TNF-alpha drugs) may exacerbate MS.

As for the Diprolene, your dermatologist is correct in that strong topical corticosteroids like Diprolene have been associated with cases of thinning skin, increased blood vessels and easy bruising.

If you want to find something that won’t make your skin feel hot and sticky, there are several other preparations of corticosteroids that come in a gel form; these are more drying than the ointments and creams. For the face, there are preparations of non-steroid medications that are available in liquids, and relatively lightweight creams (Dovonex/calcipotriene and Elidel/pamicrolimus). Protopic (tacrolimus) is a safe medication for the face but is more of a greasy ointment.

Q6. My father, 61, has full-blown psoriasis over 90 percent of his body. Dermatovate has helped to some extent, but he uses a tube a day just to get through the day. What can I do? I feel he won’t last long. The condition he has leaves him in despair. Doctors have given him drugs that have had such a bad chemical reaction. He lost his hair, nails and even teeth. And his skin got so bad he would shed huge pieces of it. Cortisone was the worst. Is there any hope?

Sounds like you are in need of some good treatment and some information. First, Dermatovate is a cortisone; in fact, it is the super-potent cortisone clobetasol that is available inexpensively outside the United States. It is almost certain that one tube a day is far too much and is likely similar to taking oral or intravenous corticosteroid (in that it’s being absorbed through the skin and therefore affecting his entire body, not just the location where it’s applied). I would encourage you to see a dermatologist for advice.

There are now better options than ever for patients with severe, disabling psoriasis. Anything from light treatments to shots (like the new biologic products) could give him relief without systemic steroids. Psoriasis could lead to hair and nail loss, but I don’t know how to respond to your report of his dental problems. I am most concerned about the potential amount of corticosteroid he is exposing himself to. He may even need to be tapered slowly. Again, find a dermatologist who has an interest in psoriasis and make an appointment as soon as possible.

Q7. My husband suffers from psoriasis, and we belong to an HMO. All they do for him is prescribe topical creams, which haven’t been working. What would be the next thing he could try?

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