Psoriasis - Topical Medications

Side Effects. The more powerful a drug, the more effective it is. But it also has a higher risk for severe side effects. They can include the following:

Burning.
Irritation.
Dryness.
Acne.
Thinning of the skin that may become shiny, fragile, and easily cut.
Dilated blood vessels.
Loss of skin color.

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Corticosteroids should not be used during pregnancy or when nursing. The high-potency drugs carry a small risk for adrenal insufficiency, which is usually mild. If this occurs, the body loses its ability to produce natural steroid hormones for a period of time after the drug has been withdrawn, which can cause serious complications. With topical steroids, however, this event is uncommon and usually mild.

Loss of Effectiveness. In most cases, the patients become tolerant to the effects of the drugs, and they become ineffective. Some experts recommend using intermittent therapy (called weekend or pulse therapy), which involves applying a high-potency topical agent for three full days each week. In one study, intermittent treatment maintained improvement for six months in 60% of patients.

Some Topical Corticosteroids Used for Psoriasis
Low potency (Some are available over the counter)	Hydrocortisone low potency (Hytone, Penecort, Synacort, Cort-Dome, Nutracort, Westcort). Desonide (Tridesilon, DesOwen). Flumethasone pivalate (Locorten). Fluocinolone acetonide (Synalar, Derma-Smoothe). Triamcinolone acetonide (Aristocort).
Low to medium potency	Alclometasone dipropionate (Aclovate). Hydrocortisone low to medium potency (Locoid, Pandel). Hydrocortisone valerate (Westcort). Prednicarbate (Dermatop).
Medium to upper-mid potency	Clocortolone pivalate (Cloderm). Fluticasone propionate (Cutivate). A low-dose ointment (0.005%) is proving to be effective for psoriasis on the face and in folds of the skin, but not in other areas. Mometasone furoate (Elocon). (Only needs to be administered once a day. May be as or more effective than corticosteroids at the same strength while having a lower risk for severe side effects.) Triamcinolone acetonide (Aureocort, Tri-Adcortyl, Kenalog). Available as a topical cream or as an injectable agent to treat nail psoriasis.
High potency	Betamethasone (Diprosone). (Also available in lower potencies.) Amcinonide (Cyclocort). Desoximetasone (Topicort). Diflorason (Florone, Maxiflor). Fluocinonide (Lidex). Halcinonide (Halog).
Very high potency	Halobetasol propionate (Ultravate). Betamethasone (Diprolene). Available as a foam (Luxiq). Clobetasol propionate (Temovate). Also available as a foam (Olux). Diflorasone diacetate (Florone, Maxiflor, Psorcon). Psorcon is a gel form that may be particularly helpful.