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Over-the-Counter Psoriasis Treatments

By Betsy Lee-Frye

Updated July 08, 2008

(LifeWire) - For some patients, psoriasis can be controlled using over-the-counter (OTC) medications. These OTC medications are often used in combination with prescription meds, but they can also have side effects when used together. Be sure to talk to a dermatologist or physician about how to use OTC remedies before incorporating them into a comprehensive treatment plan with other drugs.

OTC Corticosteroids

For most people, topical (meaning applied to the skin) corticosteroids are the first line of defense against the pervasive itch of psoriasis. Hydrocortisone 1% cream is a commonly used OTC anti-itch medication.

Hydrocortisone can be highly effective in the short term. One study found that after four weeks, 68% of patients using hydrocortisone experienced complete clearance of their psoriasis rash. (However, this study was used prescription drug Locoid, so OTC brands may be less effective.)

These products work in three ways: blocking chemicals that cause the itch response in the brain, inhibiting the body's inflammatory reaction and reducing blood flow to the affected area by constricting blood vessels.

Side effects of corticosteroids can include burning at the application site, pigmentation changes on affected skin, acne and a temporary increase in itching. These medications are not recommended for prolonged use because they are absorbed into the bloodstream and can impact internal organs. In very rare cases, corticosteroids have been shown to affect the complex interactions of the pituitary and adrenal glands, causing symptoms similar to Cushing's syndrome. Cushing syndrome, caused by elevated blood cortisol levels, can result in weight gain, profuse sweating, thinning of the skin, insomnia and reduced libido. These symptoms typically resolve after drug use is discontinued, however most of the side effects mentioned above are more likely with prescription strength cortisone than OTC varieties.

Stopping the Itch: Alternative Therapies

Several natural ingredients can also ease the itching associated with psoriasis rash. The scientific evidence is most compelling for capsaicin, which is found in cayenne peppers, and this compound works by affecting molecules at nerve endings that are responsible for transferring sensations of pain and itching to the brain. Capsaicin is available as a topical cream and can be found in a variety of brands, many of which are labeled to treat arthritis pain. According to the National Psoriasis Foundation, creams with 0.025% capsaicin are effective in reducing the redness, itching and scaling associated with psoriasis.

In addition, the National Psoriasis Foundation reports that some people with psoriasis find symptom relief using apple vinegar (either by adding it to a bath or soaking affected areas in it), emu oil (by rubbing it onto affected areas) or oats (by either adding it to a bath or mixing it into a paste with water and applying it directly to the skin). These alternative therapies have not been scientifically evaluated for effectiveness or possible side effects. Be sure to talk to a physician before beginning such treatment regimens.

Addressing Other Symptoms: Coal Tar and Salicylic Acid

Topical coal tar is likely the oldest psoriasis treatment method. It serves to reduce inflammation associated with psoriasis and slow skin cell proliferation, which is typically increased in affected areas.

Generally, coal tar-containing products are applied directly to the affected skin. To increase effectiveness, the National Psoriasis Foundation recommends that tar be "left on the skin for at least two hours."

Most people combine tar-based therapies with other treatment methods. One common strategy, the Goeckerman regimen, combines the use of tar and ultraviolet (UV) light exposure. Tar can make the skin more sensitive to light, increasing the effectiveness of the UV exposure.

Side effects of coal tar are rare, but can include skin irritation and redness. Exposure to high concentrations of tar has been linked to increased cancer risk. Experts recommend that people who use tar as a long-term method of treatment should be checked regularly for skin cancer.

The FDA has also approved the use of salicylic acid for the treatment of psoriasis. This medication is available in OTC creams, shampoos, soaps and lotions, and it reduces psoriasis scales and helps topical medications sink deeper into the skin.

Sources:

"Alternative Approaches to Psoriasis Treatment: Topical Products." National Psoriasis Foundation: Alternative Topical Products. Nov. 2006. National Psoriasis Foundation. 11 Jun. 2008 <www.psoriasis.org/treatment/psoriasis/alternative/topicals.php>.

"Cutivate (fluticasone propionate)." U.S. National Library of Medicine. 2008. National Institutes of Health. 11 Jun. 2008 <dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=7340>.

"Hydrocortisone (Hydrocortisone)." U.S. National Library of Medicine. 2006. National Institutes of Health. 11 Jun. 2008 <dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?id=861&type=display>.

"Hydrocortisone Topical." MedlinePlus Drug Information. 2007. National Institutes of Health. 11 Jun. 2008 <www.nlm.nih.gov/medlineplus/druginfo/medmaster/a682793.html>.

James, M. "A Randomized, Double-Blind, Multicenter Trial Comparing Fluticasone Propionate Cream, 0.05%, and Hydrocortisone-17-Butyrate Cream, 0.1%, Applied Twice Daily for 4 Weeks in the Treatment of Psoriasis." Cutis; Cutaneous Medicine for the Practitioner 67(Suppl 4)Apr. 2001: 2-9. 11 Jun. 2008. <www.ncbi.nlm.nih.gov/pubmed/11338723?ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed>.

ResultsPanel.Pubmed_RVDocSum>. "Over-the-Counter Products." National Psoriasis Foundation: Treatment Guide. 2008. National Psoriasis Foundation. 11 Jun. 2008. <www.psoriasis.org/treatment/guide/otc/>.

Reimann, S., T. Luger, D. Metze. "[Topical Administration of Capsaicin in Dermatology for Treatment of Itching and Pain]." Der Hautarzt; Zeitschrift für Dermatologie, Venerologie, und Verwandte Gebiete 51. 3 Mar. 2000 : 164-172. 11 Jun. 2008. <www.ncbi.nlm.nih.gov/pubmed/10789077?ordinalpos=8&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum>.

LifeWire, a part of The New York Times Company, provides original and syndicated online lifestyle content. Betsy Lee-Frye is an independent journalist living in Kansas City, Mo. Her work has appeared in The Dallas Morning News, Better Homes and Gardens Special Interest Publications and Kansas City Magazine.
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