People living with the diagnosis of psoriasis know firsthand how much depends on the right choice of medication. This disease does not forgive mistakes in treatment and neglect of their health. An important role in combating the symptoms of psoriasis is played by well-chosen external therapy and timely started treatment. The key principle in choosing a treatment regimen, especially in the early stages of psoriasis, is the principle of “do no harm” – the treatment should not affect the health of the skin, triggering the occurrence of undesirable consequences in the form of skin atrophy or withdrawal syndrome. After all, the main task of therapy is to prolong periods of rest and health of the skin without sudden and painful relapses and exacerbations.
Hormonal psoriasis ointment: treat or cripple?
A common group of external remedies for the treatment of psoriasis are ointments based on glucocorticosteroid hormones. These substances have the ability to suppress the activity of the immune system, reducing inflammation. Therefore, in severe exacerbations of psoriasis, steroids are prescribed systemically – in the form of tablets or injections. However, this approach is fraught with serious side effects: therapy changes the hormonal background of the body, and the withdrawal of drugs can lead to disruptions in the endocrine and cardiovascular systems.
Topical steroids (external hormonal agents) are partly devoid of the dangerous properties of systemic hormone-based drugs: the effect is manifested exclusively at the site of application. Their advantage is the speed of action: within a few minutes after application, the patients notice a decrease in itching, and over the next few days the redness in the area of psoriatic plaques decreases significantly, their growth and peeling stop.
However, unfortunately, side effects are also characteristic of topical steroids – and no less serious: due to a decrease in immunity at the site of application, the skin becomes thinner and discolored, there is a risk of attaching a secondary infection. This undoubtedly complicates the treatment. The most serious consequence of the use of topical steroids is the development of addiction. As a result, other means (and topical steroids themselves) already cease to help, provoking the next, sometimes stronger, relapses after discontinuation of the drugs. That is why the sale of topical steroids in Europe and the United States without a prescription is prohibited. Independent and uncontrolled use of these funds belonging to the category of potent, is unacceptable.
Addison’s disease is a condition that develops as a result of long-term use of medicinal glucocorticosteroids. In response to hormone therapy, the adrenal glands no longer produce cortisol and other steroids on their own, with symptoms such as muscle weakness, loss of weight and appetite, low blood pressure, dehydration, heart palpitations, and constant anxiety. In Addison’s disease, doctors are not always able to restore adrenal function, so patients are prescribed hormone therapy for life.
In some countries, the majority of topical steroids are inexpensive and sold without a doctor’s prescription, so this type of psoriasis treatment is often abused. Meanwhile, dermatologists do not recommend the use of local steroids for extensive (more than 20% of the skin surface) areas of damage, as well as to apply such agents to sensitive areas of the body – face, neck, skin folds and diaper spots. It is desirable to completely abandon the idea of applying hormonal ointments and creams without a doctor’s prescription: this can reduce the effect of the main treatment, harm the health and provoke an attack of severe exacerbation of psoriasis.
Common hormonal creams and ointments are made on the basis of the following substances:
- Tazarotene (“Tazorac”);
- Betamethasone (“Akriderm”, “Beloderm”, “Celestoderm”);
- Hydrocortisone (“Hydrocortisone”, “Latikort”, “Oksikort”);
- Clobetasol (“Cloveit”, “Powercourt”);
- Mometasone (“Uniderm”, “Elokom”, “Gistan N”);
- Methylprednisolone (Advantan, Comfoderm);
- Triamcinolone (Ftorocort, Triacort);
- Fluocinolone (Flucinar, Sinaflan).
Traditional non-hormonal ointment for the treatment of psoriasis: will not be worse, but better?
Given the serious side effects of hormone creams and ointments, many patients prefer to treat psoriasis with less “aggressive” drugs. Some of them are the property of traditional medicine and traditional skin treatment recipes that have been popular in the past.
The advantages of traditional non-hormonal treatment of psoriasis include its comparative safety with hormonal means, cheapness and the absence of serious side effects. The disadvantages are different (often low) degree of effectiveness and, in some cases, allergic reactions that develop in patients to the components of one or another drug.
Naftalan, Ichthyol, Dermatol, Kartalinovaya ointment, tar-based ointment – have anti-inflammatory and antiseptic action. However, some of them (for example, naphthalene ointment) cannot be used in the progressive stage of psoriasis and in large areas of damage, while others (for example, tar ointment) have a photosensitizing effect, therefore they are not recommended to be combined with phototherapy. In addition, long-term use of these funds increases the likelihood of developing skin cancer. Traditional ointments also have a rather pungent odor and may stain clothes, and therefore they are not very comfortable to use.
Keratolytics (sulfuric salicylic ointment, “Tsignoderm”) have anti-inflammatory and antimicrobial action, cause enhanced exfoliation of dead cells, which accelerates the healing process of psoriatic plaques. Possible side effects include the risk of inflammatory reactions, burning sensation and pigmentation of the surrounding healthy skin (staining of healthy skin and hair brown).
Phytopreparations (ointments and creams based on aloe vera, elecampane, celandine, sage and other herbs) have anti-inflammatory and healing effects and prevent the development of skin infections. They are auxiliary agents in the treatment of psoriasis, complementing the effect of the main treatment.
Moisturizers (children’s creams and oils, cosmetic hydrating agents: Bioderma, Vichy, Mustela and others) are also auxiliary in the treatment of psoriasis and help fight dryness and feeling of tightness of the skin. They are used in combination with drugs to enhance the effect of therapy.
Non-hormonal ointments and creams with a pronounced therapeutic effect: clinically proven
Separately, it is necessary to single out a group of non-hormonal drugs, the effectiveness of which in the local treatment of psoriasis was confirmed during clinical trials. Unlike ointments and creams from the previous group, the mechanism of action of these drugs is studied in detail. They have an indisputable advantage over hormonal drugs due to a higher safety profile. However, in the treatment of these means it is necessary to strictly adhere to the instructions for use and be aware of possible contraindications.
Pimecrolimus (cream “Elidel”) has a high anti-inflammatory activity. However, you should be aware that in the case of bacterial or fungal skin lesions, the use of pimecrolimus-based products is recommended only after curing the infection. With uncontrolled use, pimecrolimus can cause local immunosuppression of the skin (suppression of local immunity), which increases the risk of attaching a secondary infection to the affected areas of the skin. Therefore, in the USA, for example, pimecrolimus is recommended only as a “second-line” drug of treatment, that is, only in the absence of effect from other means of therapy. Pimecrolimus is prohibited for use in children up to two years.
Calcipotriol (Dayvonex cream and ointment) is a synthetic analogue of vitamin D3. Its action is based on an increase in the level of calcium in the skin cells, which normalizes the rate of their division and promotes the resorption of psoriatic plaques. Since calcipotriol is a prohormonal agent (which, after a series of biochemical reactions, turns into an active hormonal metabolite of calcium metabolism), there are a number of restrictions on its use. In particular, calcipotriol does not apply if more than 30% of the skin is affected due to the risk of hypercalcemia. The latter can cause an irregular heartbeat and muscle cramps. It is also not recommended to apply calcipotriol on sensitive skin areas (face, neck, folds). Means based on this active ingredient have age limits: for example, Dayvonex is not recommended for patients under six years of age. Calcipotriol is also not suitable as an adjuvant in the case of phototherapy treatment, since under the action of UV rays it causes photosensitivity and leads to the development of skin burns.
Zinc pyrithione (Zinocap, Skin-cap creams and aerosols). Due to the proven efficacy and safety of treatment, drugs for the treatment of psoriasis based on this active ingredient can be classified as a “golden mean”. Zinc is an organic and natural medicine for the treatment of skin diseases. Its concentration in the healthy human epithelium is about 20% of the total content in the body, and the deficiency of this valuable metal is accompanied by various skin lesions and impaired wound healing. Drugs with active zinc (zinc pyrithione) have a whole complex of specific properties (anti-inflammatory, antibacterial, antifungal), help reduce skin itch, promote the production of ceramides (lipids) of the skin, which leads to the restoration of its barrier function. Zinc pyrithione products activate the so-called apoptosis (natural programmed death) of pathologically altered skin cells and inflammatory cells, thereby activating the natural renewal of epithelial cells, reducing peeling and eliminating psoriatic plaques. Studies have shown that active zinc has an efficacy comparable with hormonal agents and, at the same time, a good safety profile, since it is practically not absorbed from the surface of the skin and has no irritating and damaging effect.
Ointment or cream?
Many of the above listed medicines are available both as an ointment and as a cream. How to choose the most suitable form?
Ointments have a more dense and oily texture, which allows the drug for a long time to be on the surface of the skin, especially if applied under a bandage.
The cream has a softer texture, is easier to apply and absorbs faster, making it possible to apply it, leaving the skin open, not using dressings and not being afraid to get your hands or clothes dirty. As a rule, the cream has a pleasant smell, which is also important for daily application.
Unlike ointments, the cream is less irritating, therefore it is better suited for application to the face, flexor surfaces of joints, and areas with increased sensitivity. Also, the ointment is not suitable for application to the moist areas of the affected skin with liquid discharge. The cream in this sense is more versatile.
Traditionally, psoriasis ointments are presented more widely, but this imbalance is gradually leveling – more and more new dosage forms in the form of creams, gels, as well as aerosols suitable for use and especially suitable for application to hard-to-reach areas (for example, the scalp) appear on the market.