How to get a prescription cream and ointment for psoriasis?

Table of Content:
What is psoriasis? | Prescription creams and ointments for psoriasis | Topical corticosteroids | Topical calcineurin inhibitors | Topical vitamin D analogs | Vtama cream | Zoryve cream | Tazarotene | Anthralin FAQ

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The treatment of psoriasis has evolved considerably during the last few years, and this dermatologist guide, by Dr. Ryan Trowbridge, board-certified dermatologist, gives you a complete overview of the most widely prescribed as well as the newer topical creams and ointments for psoriasis.

What is psoriasis?

Psoriasis is a chronic inflammatory condition characterized by the formation of scaly plaques on the skin that appear as a result of uncontrolled inflammation.  

Psoriasis is characterized by the accelerated growth of skin cells which leads to the accumulation of cells on the surface of the skin and the formation of scaly skin patches especially on different parts of the body. 

Although psoriasis mostly affects the skin, it may be associated with other health conditions, most commonly arthritis.  It has also been linked to increased rates of heart disease, and possibly many other problems including diabetes, anxiety and depression, and inflammatory bowel disease.  Rarely, it can have an impact on the eyes.

Patients with psoriasis often go through cycles of symptoms, experiencing periods of flare-ups that can last several weeks before diminishing.

Do I need a prescription for psoriasis treatment creams?

Yes, most psoriasis treatment creams and ointments require a doctor’s prescription as they are not sold over the counter.

What are the best prescription ointments and creams for psoriasis?

This table highlights the diversity of approaches in the treatment of psoriasis, ranging from immune modulation and inflammation reduction to normalization of skin cell growth and differentiation. Each treatment has unique benefits and mechanisms, making them suitable for different types and severities of psoriasis, as well as for different areas of the body.

Prescription creams and ointments for psoriasis

Are there other psoriasis medications besides topical creams?

Yes, besides topical creams there is a wide range of medications for psoriasis that are taken orally or administered by self-injection. 

Which psoriasis treatment ointment and creams can I get?

Dr. Trowbridge says that topical steroids are still the most common topical medications he prescribes to his patients for psoriasis.  These include: hydrocortisone, triamcinolone acetonide, fluocinolone acetonide, betamethasone dipropionate, mometasone furoate, and clobetasol propionate.  They are safe when used appropriately and relatively affordable, which makes insurance coverage common.  

Topical tacrolimus and pimecrolimus are two similar medications that are also often prescribed, as well as the vitamin D analogue calcipotriene.  They are often required by insurance in step therapy, and have their place used in conjunction with topical steroids on certain body areas, but tend to be less effective when used on their own.  

Newer medications like Vtama and Zoryve can also be helpful, and may work as well or better as topical steroids in certain situations, but they are very expensive when not covered by insurance.  

Anthralin and tazarotene are prescribed infrequently, but may be used by patients who want to treat their psoriasis with topical medications alone.

List of psoriasis treatment creams 

Topical corticosteroids

Dr. Trowbridge says that topical corticosteroids are often used as a first-line treatment for mild to moderate psoriasis and may be combined with other therapies. Some corticosteroids prescribed for psoriasis are: hydrocortisone, triamcinolone acetonide, fluocinolone acetonide, betamethasone dipropionate, mometasone furoate, and clobetasol propionate³.

How do topical corticosteroids work for psoriasis?

• Anti-inflammatory action: Corticosteroids reduce inflammation in the skin, which is a key component of psoriasis plaques. This action helps to decrease redness, swelling, and discomfort associated with inflamed skin.

• Immunosuppressive effects: These medications suppress the immune system’s activity in the skin. This suppression helps to reduce the rate of skin cell turnover, leading to a decrease in scaling and thickness of plaques.

• Vasoconstrictive properties: Corticosteroids cause the blood vessels in the skin to constrict (narrow), which can reduce the amount of blood flow to the skin. This can help to decrease redness and the appearance of psoriasis plaques.

• Reduction of skin cell production: By affecting the function of various cells and chemicals in the skin, corticosteroids can slow down the overly rapid production of skin cells, which contributes to plaque formation and scaling in psoriasis⁴.

Formulation of topical corticosteroids for psoriasis treatment

Topical corticosteroids used for the treatment of psoriasis are available as ointments, creams, lotions, gels, foams, oils, solutions, and shampoos. The strength of the corticosteroid prescribed depends on the duration of treatment, the frequency of application, the skin location, and the total surface area treated⁵.

Topical calcineurin inhibitors

Dr. Trowbridge says that topical calcineurin inhibitors are frequently used topical therapies  for the treatment of psoriasis. Tacrolimus (marketed under the brand name Protopic) and pimecrolimus (sold under the brand name Elidel) inhibit calcineurin, a protein phosphatase that is essential for the activation of T-cells, which are a type of white blood cell involved in the immune response that causes psoriasis.  They are particularly helpful in addition to topical steroids and in areas more sensitive to topical steroids like the skin of the face, groin and genitals, and perianal area⁶.

How do topical calcineurin inhibitors work for psoriasis?

• Inhibition of T-cell activation: T-cells play a crucial role in the immune system’s response that leads to the inflammation and cell turnover seen in psoriasis. By inhibiting calcineurin, these drugs reduce the activation of T-cells, thus decreasing the immune response that contributes to psoriasis symptoms.

• Reduction of inflammatory cytokines: With the activation of T-cells suppressed, the production of inflammatory cytokines (proteins that signal and regulate inflammation) is also reduced. This leads to a decrease in inflammation and the associated symptoms of psoriasis, such as redness, itching, and scaling.

• Indirect impact on skin cell turnover: Although not their primary mode of action, by reducing inflammation and the immune response, topical calcineurin inhibitors can also indirectly affect the rapid skin cell turnover associated with psoriasis, helping to reduce the formation of psoriatic plaques⁷.

Formulation of topical calcineurin inhibitors for psoriasis

• Topical tacrolimus comes as a psoriasis ointment. Tacrolimus can also be found as an oral and intravenous medication, but it is not used for psoriasis.
• Pimecrolimus is mainly available as a psoriasis treatment cream.

Topical vitamin D analogs

Similar to topical calcineurin inhibitors, calcipotriene (marketed under the brand name Dovonex) and Calcitriol (sold under the brand name Vectical) are used often in conjunction with topical steroids and on more sensitive skin areas.

How do topical vitamin D analogs work for psoriasis?

• Regulation of Skin Cell Growth: Vitamin D analogs slow down the rapid proliferation (growth) of keratinocytes, which are the predominant cells in the outer layer of the skin. In psoriasis, these cells multiply faster than normal, leading to the buildup of skin cells that form thick, scaly plaques. By normalizing the growth rate of these cells, vitamin D analogs help to reduce the formation of plaques.

• Promotion of Cell Differentiation: These compounds also promote the differentiation of keratinocytes. Differentiation is the process by which cells mature and acquire a specific function. In the context of psoriasis, promoting the differentiation of skin cells helps to normalize the structure and function of the skin’s outer layer, further helping to reduce scaling and thickness of psoriatic plaques.

• Anti-inflammatory Effects: Vitamin D analogs have been shown to have anti-inflammatory properties. They can help reduce the inflammation associated with psoriasis, leading to a decrease in redness and discomfort.

• Immunomodulatory Actions: Although less pronounced than their effects on skin cell growth and differentiation, vitamin D analogs can also modulate the immune response, which is overactive in psoriasis. This can contribute to their overall efficacy in reducing psoriasis symptoms⁸.

Formulation of topical vitamin D analogues for psoriasis

• Calcipotriene is available as a cream and ointment for psoriasis.
• Topical calcitriol is available as a topical ointment for psoriasis. It can also be purchased as tablets and injections for vitamin supplementation, but its effectiveness as a treatment for psoriasis in this formulation is unproven

Vtama cream

Vtama (with tapinarof as the active ingredient) is a topical cream for psoriasis that represents a novel approach to treating psoriasis by leveraging the body’s natural responses to environmental signals, offering potential benefits beyond just skin health due to its mechanism of action. The FDA recently approved its use as a safe and effective treatment option for patients aged 18 and above.  It’s a promising new class of medication for psoriasis, but with a shorter track record than previously discussed options⁹. 

How does Vtama work for psoriasis?

• Uses the body’s environmental response pathways: By doing this, tapinarof offers a new avenue for treatment that could potentially overcome the limitations or side effects associated with existing medications.

• Reduces inflammation: It lowers the levels of pro-inflammatory cytokines related to psoriasis and atopic dermatitis, which helps reduce inflammation in the skin.

• Strengthens skin barrier: It boosts the production of proteins crucial for the skin’s barrier function, helping restore damaged skin.

• Boosts antioxidant response: It enhances the body’s antioxidant defense system through a protein that helps protect against oxidative stress¹⁰.

Formulation of Vtama

Vtama is available as a psoriasis cream that requires a prescription.

Zoryve cream

Zoryve (with roflumilast as the active ingredient) is a newly FDA-approved prescription cream used to treat psoriasis. It works by blocking  the PDE4 enzyme, which plays a significant role in the inflammation process. By doing this, roflumilast reduces the production of inflammatory cytokines, which are proteins that contribute to the inflammation seen in psoriasis¹¹. 

How does Zoryve cream work for psoriasis?

• Inhibition of PDE4 enzyme and increased cAMP levels: Roflumilast selectively inhibits the PDE4 enzyme and increases cAMP levels leading to a reduction in the release of pro-inflammatory cytokines resulting in a reduction of psoriasis symptoms¹².

• Anti-inflammatory effect: The increase in cAMP levels exerts an anti-inflammatory effect by downregulating the inflammatory response, redness, and scaling associated with psoriasis plaques¹³.

• Immunomodulatory actions: Roflumilast has immunomodulatory effects, meaning it can alter the immune system’s behavior. By affecting the activity of various immune cells involved in the psoriasis pathway, it helps to control the overactive immune response characteristic of the disease¹⁴.

Formulation of Zoryve

Zoryve is available as a prescription cream, ointment or foam for psoriasis.

Tazarotene

Dr. Trowbridge says that retinoids have many therapeutic benefits for the skin and Tazarotene is not an exception. This third generation topical retinoid works by modulating the growth and differentiation of skin cells, making it a potentially effective treatment. Its mechanism of action involves several key processes that may help manage psoriasis symptoms¹⁵.

How does tazarotene work for psoriasis?

• Reduction of keratinocyte hyperproliferation: It also reduces the excessive proliferation (rapid growth) of keratinocytes seen in psoriasis. This action helps to decrease the thickness of the psoriatic plaques and reduces scaling.

• Anti-inflammatory effects: Tazarotene has been shown to exhibit anti-inflammatory properties, albeit much less effectively than topical steroids. It can reduce the expression of genes involved in the inflammatory process, thus decreasing the inflammation associated with psoriasis plaques.

• Influence on gene expression: As a retinoid, tazarotene binds to retinoid acid receptors (RARs) in the skin, which influences the expression of genes involved in cell growth, differentiation, and inflammation. This genetic regulation is crucial for correcting the abnormal skin cell behavior seen in psoriasis¹⁶.

Formulation of Tazarotene

Tazarotene is available as a topical cream, gel and foam for psoriasis.  

Anthralin 

Anthralin (also known as Zithranol) is a topical prescription cream that in some circumstances can be highly efficient in the treatment of psoriasis. It has been used for many years to manage symptoms, and it is applied directly to the affected skin areas¹⁷. 

How does anthralin work for psoriasis?

• Normalization of skin cell growth: Anthralin appears to normalize the growth rate of skin cells. By slowing down the excessive proliferation of keratinocytes (the predominant cells in the outer layer of the skin), it helps to reduce the formation and thickness of psoriatic plaques.

• Anti-inflammatory effects: Anthralin has anti-inflammatory properties that help reduce the inflammation associated with psoriasis. This can lead to a decrease in redness and itching.

• Inhibition of DNA synthesis: Anthralin is known to inhibit DNA synthesis in rapidly dividing cells. This action contributes to its effectiveness in slowing down the abnormal growth of skin cells^{18 19} .

Formulation of anthralin

Anthralin is available as a cream, ointment, paste, or shampoo for psoriasis.

Frequently asked questions about creams and ointment for psoriasis

Is there a prescription cream for psoriasis?

Yes! Dr. Trowbridge says that there are several prescription creams with very different mechanisms of action available in the market for the treatment of psoriasis such as topical steroids, tacrolimus, pimecrolimus, calcipotriene, anthralin, tazarotene, Vtama, and Zoryve.  

What is the very best cream for psoriasis?

According to Dr. Trowbridge, selecting the “very best” cream for psoriasis that universally outperforms others is challenging because individual responses to treatments can vary widely.  Although steroids are generally the most effective with the longest track record for success, there are many  non-steroid creams such as tacrolimus, pimecrolimus, calcipotriene, anthralin, tazarotene, Vtama, and Zoryve that are all potentially effective medications for psoriasis.

What is the strongest psoriasis cream?

Dr. Trowbridge says there are seven classes of topical steroid ranked by potency, with 1 being the most potent (“super potent”). Clobetasol is class one, as well as halobetasol, desoximetasone, diflorasone, and some formulations of betamethasone and fluocinonide.

What is the new cream for psoriasis?

Dr. Trowbridge says there are two fairly new topical treatments for psoriasis which are Vtama (tapinarof) and Zoryve (roflumilast). They both have a novel approach to psoriasis, and since they are both non-steroid creams they can be used for more sustained periods than topical steroids without many of the same risks of overuse. 

Why is Vtama cream so expensive?

Vtama cream is so expensive because it is a novel treatment for psoriasis with a unique mechanism of action. To develop this drug, Dermavant Sciences, the pharmaceutical company behind it, had to invest on high research and development costs, a complex manufacturing process, which earned a status as a first-of-its-kind therapy. 

Do prescription cream and ointment work for severe psoriasis?

Dr. Trowbridge says that if you have severe psoriasis, you may need to use oral psoriasis medication, or the so-called biologic medications for psoriasis, which are administered by self injection for the treatment of severe psoriasis.

 

The takeaway

Despite psoriasis being a long-term inflammatory disease, employing stress management strategies, pinpointing and controlling your triggers, and receiving prompt treatment can help you remain largely symptom-free for extended periods. Consult with your online dermatologist or seek out a local dermatologist to develop a treatment plan tailored to your needs.

Talk to your online dermatologist, or find a dermatologist in your area to get the treatment plan for you. 

Did you know that psoriasis can also affect the face, causing redness and scaling? For more details on managing facial psoriasis, check out our in-depth article “Psoriasis on face: What is it and how to get rid of it?“

Article References:
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https://karger.com/spp/article-abstract/3/1/1/819244/Dithranol-A-Review-of-the-Mechanism-of-Action-in
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