Coal tar preparations

These have been used to treat psoriasis for many years. It is not clear how they work. They may reduce the turnover of the skin cells. They also seem to reduce inflammation and have 'antiscaling' properties. There are various brands and types. Traditional tar preparations are messy to use, but modern formulas are more pleasant. Tar based shampoos are popular for scalp psoriasis. You should not use tar on the face, or on any broken or sore skin.

Dithranol

This has been used for many years for psoriasis. In most cases a daily application of dithranol to a psoriasis plaque will eventually cause it to go. However, dithranol irritates healthy skin. Therefore you need to apply it carefully to the psoriasis plaques only. To reduce the chance of skin irritation, it is usual to start with a low strength and move onto stronger ones gradually over a few weeks. When applying dithranol, you should protect your hands with gloves, or wash your hands thoroughly afterwards.

There are various types of dithranol preparations. 'Short contact therapy' is popular. This involves putting a higher strength dithranol on the plaques of psoriasis for 15-60 minutes each day, and then washing it off. Dithranol may stain skin, hair, clothes, bedding, baths, etc.

Steroid creams or ointments

These work by reducing inflammation. They are sometimes prescribed for short periods for areas of skin with thick plaques. Ideally, they should not be used for more than 4-6 weeks at a time. This is because the skin may become used to or 'tolerant' to steroids if used longer. Side-effects with long term use may also occur. They are easy to use and may be a good treatment for difficult areas such as the scalp and face. Steroid lotions are useful for flare-ups of scalp psoriasis.

Tazarotene

This is another cream that is sometimes used. Irritation of the normal surrounding skin is a common side-effect. This can be minimised by applying tazarotene sparingly to the plaques and avoiding normal skin.

Salicylic acid

This is sometimes combined with other treatments such as coal tar or steroid creams. It tends to loosen and 'lift' the scales of psoriasis on the body or the scalp.

For scalp psoriasis

A tar-based shampoo is often tried first and often works well. Some preparations combine a tar shampoo with either a salicylic acid preparation, a coconut oil/salicylic acid combination ointment, a steroid preparation, calcipotriol scalp application, or more than one of these.

Combinations

Some preparations use a combination of ingredients. For example, calcipotriol combined with a steroid may be used when calcipotriol alone has not worked very well. As mentioned, it is not usually wise to use a steroid long-term. Therefore, one treatment strategy that is sometimes used is calcipotriol combined with a steroid for four weeks, alternating with calcipotriol alone for four weeks.

Other combinations such as a tar preparation and a steroid are sometimes used. Other 'rotating' treatment strategies are sometimes used. For example, a steroid for a few weeks followed by a course of dithranol treatment.

Scalp treatments often contain a combination of ingredients such as a steroid, coal tar, and salicylic acid.

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