What psoriasis treatments are available without a prescription?

Some OTC treatments contain an active ingredient (what treats the psoriasis) like coal tar or hydrocortisone. People have used these for years to treat psoriasis. Other active ingredients are so new that we know little about how well they work or whether they’re safe.

Here’s what we know about OTC psoriasis treatment: 

Coal tar
This active ingredient is found in many psoriasis treatments—both prescription and OTC products. Coal tar has been used for years to treat psoriasis because it can: 

• Lessen the itching and flaking

• Reduce redness, swelling, and scaling

• Slow the rapidly growing skin cells

You’ll find coal tar in OTC shampoos, creams, ointments, and bath solutions for psoriasis.

Coal tar can irritate skin

Coal tar may irritate your skin, so it’s best to test the product on a small area before applying it to all of your psoriasis.

Hydrocortisone creams and ointments

You can buy a mild corticosteroid like hydrocortisone without a prescription. For a few small patches of psoriasis, a mild hydrocortisone works well. If you have more than a few small patches, you’ll likely need a prescription corticosteroid to see results.

Whether OTC or prescription, this medicine works quickly to:

• Reduce the itch

• Decrease inflammation

If you have cracked or bleeding skin, an ointment will likely feel better than a cream. Ointments tend to be more soothing and less irritating than creams. 

Moisturizer
This may help anyone who has psoriasis because psoriasis makes the skin dry and scaly. Moisturizer helps to seal water in the skin, which can:

• Relieve dryness

• Help your skin heal

Dermatologists recommend applying moisturizer once a day, and more often when your skin is really dry. When shopping for a moisturizer, you want to select a:

• Heavy cream, ointment, or oil rather than a lotion

• Fragrance-free product

• Product that you like and will use

Oil can be especially healing, but it’s also messy. To reap the benefits of oil, try applying it before bedtime.

Moisturize after washing

For best results, apply your moisturizer after getting out of a bath or shower and after washing your hands.

Scale softeners
You’ll find OTC products and prescription medicines that contain salicylic acid. This active ingredient helps to:

• Remove and soften scale

• Reduce swelling

Because it can effectively remove scale, salicylic acid is often found in products for scalp psoriasis. Your dermatologist may also include salicylic acid in your treatment plan if you have thick plaque-type psoriasis anywhere on your body. 

Removing the scale helps other medicine that you apply to your skin to work better.

It is important to use products containing salicylic acid as indicated in the instructions. Too much can worsen psoriasis, causing dry, red, itchy skin where you applied it.  Other active ingredients that can soften and remove scale are: 

• Lactic acid

• Urea

Scale softeners

To get the best results from a scale softener, it helps to take a warm (NOT hot) 15-minute bath before you apply this product.

Anti-itch products
Some people say that the itch is the worst thing about having psoriasis. The best way to get rid of the itch is to treat the psoriasis. Until you start seeing results from treatment, using an anti-itch product can help. Look for a product that contains calamine, camphor, hydrocortisone, or menthol. These ingredients tend to work best on itchy psoriasis.

If you decide to use an anti-itch product, beware that it can irritate and dry your skin. You can prevent this by finding one that feels moisturizing and soothing or by using moisturizer along with your anti-itch product. 

Complementary and alternative treatments

You’ll find plenty of these for treating psoriasis. The US Food and Drug Administration (FDA) doesn’t regulate these products. As such, few of these treatments have been studied. Those that have been studied were tested on small numbers of people, so we don’t know how well these treatments work. We also don’t know whether they’re safe.

How a dermatologist can help

With so many products, it can be difficult to know what to use. If you don’t see the results you like with OTC treatment for psoriasis, you may want to see dermatologist. Dermatologists are the skin disease experts. They know how to tailor psoriasis treatment to the type of psoriasis you have. Sometimes, this requires combining treatments. You may also need one treatment plan to gain control over your psoriasis and another to maintain the results.

Images
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References
Menter A, Korman NJ, et al. “Guidelines of care for the management of psoriasis and psoriatic arthritis. Section 3: Guidelines of care for the management and treatment of psoriasis with topical therapies.” J Am Acad Dermatol. 2009 60(4):643–59.

Paghdal KV, Schwartz RA. “Coal tar: Back to the future.” J Am Acad Dermatol. 2009 Aug;61(2):294-302.