As psoriasis is a skin disease, topical medication is one of the most commonly used methods to treat psoriasis and is suitable for patients whose lesion area does not exceed 25% of their body surface area. They are safer because they are used in small areas, have less absorption, have fewer toxic side effects and are less likely to cause damage to liver and kidney functions.
Next, we will talk about the common types of topical drugs, specific drugs, and precautions when using them.
First, what are the common types of topical drugs for psoriasis?
1, emollient: can soften the stratum corneum and promote desquamation, such as petroleum jelly and blister oil emulsion composed of mineral oil and paraffin, used for the treatment of mild psoriasis, can be used alone or in combination with other drugs, and has become the basic treatment drug for psoriasis.
2.Keratin contributing agent: used for various types and different stages of psoriasis lesions, helps to eliminate scales, commonly used are 1%~5% salicylic acid and black bean distillation oil ointment.
3, tar preparations: can inhibit DNA synthesis and reduce the mitotic rate, can also enhance the photochemical effect, commonly used coal tar, sugar luting oil, black bean luting oil, etc.. Among them, 1% pure coal tar lotion has a better effect on scalp psoriasis.
4.Anthralin: It has anti-inflammatory and anti-proliferative effects on skin lesions. The concentration of anthralin ointment is 0.1%~0.5%, which is especially suitable for hypertrophic leathery plaque damage.
Its advantage is that it is safe, economical and has no systemic adverse reactions; the disadvantage is that it has a certain irritating effect on local skin, especially on wrinkled parts, and also pollutes clothing and is not easy to wash off. If formulated into creams, pastes or gels, etc. can make adverse reactions reduced.
5, corticosteroid preparations: is the most used topical drugs for the treatment of psoriasis, the drugs are effective, easy to obtain, do not pollute clothing, and there are many products to choose from, including weak, medium-acting, strong and super-strong drugs.
Commonly used corticosteroids are strong clobetasone propionate, clofloxysone, weaker hydrocortisone, dexamethasone and mometasone furoate, etc.
Super-potent corticosteroids are chosen for relatively small, thick plaque lesions in the palmoplantar and extremity areas, and can even be sealed, and then switched to medium- and low-intensity corticosteroids when the lesions become thinner.
Topical corticosteroids are effective in the treatment of psoriasis, but they should not be used for a long time in a large area. At higher doses, systemic adverse effects of corticosteroids and rebound effects after discontinuation of the drug can occur. Local adverse reactions include skin atrophy, capillary dilation, acne, hirsutism and pigmentation, etc.
6.Vitamin D3 derivatives: Currently, the commonly used drugs include carboplatinum ointment, which is currently the main drug used as control therapy and maintenance therapy in the treatment of chronic plaque psoriasis. Adverse reactions are mainly irritating symptoms around the lesions, such as burning sensation, itching, erythema, flaking and dryness, etc. Adverse reactions are more likely to occur on the head and face.
7.Vitaminic acid: It can be used for the control and maintenance treatment of chronic plaque psoriasis, which can inhibit the abnormal proliferation and differentiation of epithelial cells and promote the normalization of epithelial keratinization.
Second, what are the precautions when using topical drugs for psoriasis?
1.Before applying topical drugs, it is advisable to wash away the scales with warm water so that the drugs can play their role better.
2, in the acute stage of psoriasis, when the inflammation of the lesions is obvious, it is not appropriate to use topical drugs with strong irritation, such as anthralin, high concentration of vitamin A acid, etc., so as not to stimulate the occurrence of erythroderma, and in the stable stage, stronger drugs can be used.
3, drug concentration should start from low concentration, depending on the reaction after use gradually increase the concentration.
4, when the lesion area is large, the use of a drug too much can lead to absorption poisoning. Therefore, the lesions should be divided into several different areas and different drugs should be used separately.
5.Follow the doctor’s instructions to use the drug strictly, do not stop or reduce the drug at will.
References
[1]Zheng Xiaofeng,Jin Hongzhong. Research progress of topical drug treatment for psoriasis[J]. Chinese Journal of Dermatology,2016,49(04):296-299.
[2]Liu Yuehua. Topical drug treatment of psoriasis[J]. Chinese general medicine,2005(12):954-955.