OTC Treatment

Moisturizers:

Moisturizers help control scaling and dryness and may improve associated itching. They should be applied immediately after bathing and at other times during the day. Moisturizers should be applied in the direction of the hairs to minimize the risk of pimple like eruptions. Vaseline®, Eucerin® and Aquaphor® are all occlusive sticky products that can be of benefit.

Tars:

Tars are available as shampoos, soaps, gels, lotions, creams, ointments, and bath oils. Coal tar has been used since at least the beginning of the last century. These products can be combined with topical corticosteroids. These products make the skin sensitive to ultra violet-A light waves (UVA). They are often used in combination with ultra violet-B light waves (UVB). Folliculitis can be a side effect.

Tar shampoos are commonly used to treat scalp psoriasis however, they may discolor white hair turning it a yellowish color. Side effects are related to skin irritation and staining of skin and clothing.

They also tend to have an unpleasant odor.

Salicylic Acid:

Salicylic acid moisturizers and shampoos help remove some of the scales seen in psoriasis, it may be useful in reducing the thickness of psoriatic scale, but care must be taken to be gentle to the skin to prevent flaring of the psoriasis. It may be combined with tar, anthralin, and topical corticosteroids.

It is true that compounding calcipotriol and salicylic acid is not recommended because calcipotriol could be inactivated in an acidic environment. However, application of salicylic acid to the skin does not influence skin surface pH enough to influence the stability of calcipotriol in its in vivo situation. A combination treatment of Dovonex* and Psorimed® (10% salicylic acid, marketed by LEO Pharma in Germany) is actually recommended for the treatment of scalp psoriasis: Dovonex* is used in the morning and salicylic acid in the evening for the first 3-4 days; or salicylic acid is applied for 3-4 days followed by Dovonex* twice daily with no expected special risk of accelerated calcipotriol breakdown.

Other Shampoos:

There are many over the counter dandruff shampoos which can improve scalp psoriasis, particularly the scaling. They include the tar and salicylic acid shampoos listed above, ketoconazole and zinc pyrithione also.

Hydrocortisone Cream:

Hydrocortisone cream may improve psoriasis on the face and in the skin folds and improve itching. A stronger prescription topical corticosteroid is usually required to improve psoriasis lesions elsewhere.