Psoriasis Cream: OTC and Prescription Options

Psoriasis is a skin condition that causes skin to appear scaly and inflamed. It occurs when the immune system goes into overdrive, causing the skin cells to multiply quickly.

Psoriasis can affect different body parts, including the scalp, elbows, or knees. Common symptoms include scaly, dry, cracked, or itchy skin. People with lighter skin tones may develop red or pink skin patches, and people with darker skin tones may develop purple or brown skin patches.

There is no known cure for psoriasis, but treatment to help manage symptoms is available. This includes over-the-counter and prescription-strength creams.

For many people with mild psoriasis, dermatologists (doctors who specialize in skin, hair, and nail conditions) may suggest over-the-counter (OTC) creams to help manage symptoms. These creams can reduce itching, protect the skin barrier, and exfoliate the skin. They might take longer to work than prescription-strength creams.

1. Steroid Creams 

Mild corticosteroids, like hydrocortisone cream, can be purchased without a prescription to help manage psoriasis symptoms. Prescriptions are required for more potent corticosteroid creams.

Hydrocortisone creams decrease inflammation, which can help reduce redness, swelling, and itching. These creams usually work well for a few patches of psoriasis. For larger patches, you will need prescription-strength steroids. It’s best to use steroid creams only on affected areas.

Side effects of hydrocortisone creams include acne, skin burning or dryness, unwanted hair growth, and skin changes.

2. Scale Softeners

Scale softeners/lifters, also known as keratolytics, can help soften scales and remove the hardened outer layer of the skin.

Scale softeners contain ingredients like urea and salicylic, glycolic, and lactic acids. A dermatologist may prescribe scale softeners to help other topical medicines work better. It’s recommended you take a warm, 15-minute bath before using a scale softener for the best results. 

One downside of scale softeners, especially salicylic acid-containing creams, is that they can be too harsh for the skin. Using these creams more than necessary can also worsen psoriasis symptoms. Serious side effects include ringing in the ears, fast breathing, and confusion.

3. Coal Tar

Coal tar is a byproduct of coal, made during the production of coke (a solid fuel made mostly of carbon) and coal gas.

Certain preparations of coal tar can be used to treat skin conditions like psoriasis. People have been using coal tar for psoriasis for more than 100 years, and it’s approved by the United States Food and Drug Administration (FDA).

Coal tar creams can be an effective treatment for psoriasis symptoms, even in difficult-to-treat areas on the palms and soles.

Some people may see complete skin clearing with coal tar, but the extent of success may depend on the strength of the coal tar lotions. One study showed that lotion with 1% coal tar worked better than lotion with 5% coal tar. Ask a dermatologist what strength would be best for you.

Coal tar has some drawbacks, including an unpleasant odor, stained skin and clothing, and skin irritation. Stop using coal tar if you experience severe stinging, burning, or worsening psoriasis.

Coal tar may not be a good choice if you are sensitive to the sun or take medicines, such as retinoids, that make you more sensitive.

4. Anti-Itch Creams

Anti-itch creams containing ingredients like calamine, camphor, and menthol can help relieve the itchiness of psoriasis.

These products can irritate or dry your skin, which can, in turn, worsen psoriasis symptoms. It is best to use a moisturizer when using an anti-itch cream.

For moderate to severe psoriasis, your healthcare provider may recommend prescription-strength creams alone or in addition to other treatments. They may also prescribe these stronger creams if OTC options aren’t effective for your case.

Some prescription creams that may help treat psoriasis include:

1. Topical Steroids 

Steroids come in different strengths and potencies. Prescription-strength steroids are stronger and are a preferred treatment for moderate to severe psoriasis. They help reduce inflammation and prevent skin cells from overgrowing.

Some steroid creams that may be prescribed for psoriasis include:

• Ultra-high steroids, such as Clobex (clobetasol) 0.05% cream
• High-potency steroids, such as Cyclocort (amcinonide) 0.1% cream
• Moderate-potency steroids, such as Alphatrex (betamethasone dipropionate) 0.05% cream 

The effectiveness of topical steroid creams tends to increase with strength, as do the side effects. Side effects of prescription-strength steroids include worsening acne, itching, stretch marks, thinning of the skin, and red or purple spots on the skin.

Apply steroid creams only to the affected areas, and do not use them longer than three weeks without consulting a healthcare provider.

2. Keratolytics

Keratolytics are drugs that help remove excess skin. Prescription keratolytic cream can help slow skin growth and remove skin scales. Dermatologists may prescribe keratolytics to speed up the shedding of thick, rough skin, repair damaged skin, and relieve itching.

These topical creams include Tazorac (tazarotene) and prescription-strength salicylic acid, sold under brand names like Salex and Keralyt.

Tazarotene can cause burning, itching, and skin redness, especially when used at high concentrations. To reduce your risk of side effects, your dermatologist may recommend using a lower-strength cream, combining it with a moisturizer, or applying it every other day.

Prescription-strength salicylic acid also has a penetrative ability that helps other psoriasis creams work better. Some side effects of salicylic cream include tooth pain, headache, dizziness, hearing problems, and vomiting.

3. Calcineurin Inhibitors

The FDA has approved calcineurin inhibitors like Protopic (tacrolimus) and Elidel (pimecrolimus) to treat dermatitis (eczema). Dermatologists may also prescribe these creams off-label—meaning for a different purpose than was approved—to manage psoriasis symptoms.

Protopic and Elidel creams suppress the immune system and reduce inflammation by blocking calcineurin, a protein that contributes to inflammation. Dermatologists more often prescribe these medications to treat facial and genital psoriasis.

You can safely apply calcineurin inhibitors to affected areas twice daily and may see results within 1-4 weeks of application. See a healthcare provider if you do not see an effect after four weeks or if your symptoms worsen.

Side effects include burning, tingling, and worsened itching, but these effects often improve with continued use. The FDA also warns of a possible cancer risk with these medicines, though this is based on animal studies and has not been seen by dermatologists.

4. Vitamin D Analogues

Vitamin D analogs, such as Dovonex (calcipotriene) and Vectical (calcitriol), treat mild to moderate psoriasis in people 18 years or older.

These creams slow down the growth of rapidly dividing cells and aid skin repair by increasing cell differentiation. Dermatologists may prescribe vitamin D analogs to flatten thick psoriasis and remove scales. The cream is usually applied twice a day, around the same time.

Vitamin D analogs are generally safe, but some people experience side effects such as burning, peeling, itchiness, and dryness.

5. Zoryve (Roflumilast) Cream

Zoryve is a cream version of the drug roflumilast. It is approved to treat psoriasis in people older than 6. It works by blocking a molecule called phosphodiesterase-4 (PDE4), which plays a role in inflammation.

Zoryve is steroid-free and can treat psoriasis in sensitive areas (e.g., the face) and where the skin folds together (e.g., underarms, buttocks, beneath the breasts).

This cream is usually applied once daily to the affected areas to reduce itching. Side effects include diarrhea, headache, and increased blood pressure.

6. Vtama (Tapinarof)

Vtama is a cream that is approved to treat plaque psoriasis. It is applied to the affected area once a day in a thin layer.

Vtama acts as an aryl hydrocarbon receptor (AHR) agonist. It sticks to and activates AHR, a protein that regulates immune response. When AHR is activated, your inflammatory response decreases. Vtama is the first drug of this type to be approved for plaque psoriasis.

Vtama may also regulate filaggrin and loricin, two proteins that protect the skin barrier.

Common adverse effects include inflamed hair follicles (folliculitis) and the common cold. Headache may also be a side effect. Another potential side effect of Vtama is irritant contact dermatitis—when skin becomes red, sore, or inflamed after coming in direct contact with an irritating substance.

Avoid using products containing the following ingredients if you have psoriasis, as they may irritate your skin or lead to a flare:

• Alcohol: Creams containing alcohol can dry out your skin, resulting in worsened itching.
• Fragrance: For some people, fragrance products can irritate the skin further. 
• Sulfates: Look for sulfate-free products, as sulfate-containing creams can irritate the skin.

If you have used psoriasis creams without any reduction in symptom severity, or if the affected area is too large to use creams, see a healthcare provider for alternative treatments.

Depending on the severity of your case, dermatologists may recommend an oral medication to be used alone or with topical creams. Some prescription oral medications to manage psoriasis include Rheumatrex (methotrexate), Otezla (apremilast), Soriatane (acitretin), and Sotyktu (deucravacitinib).

Your provider may also recommend biologics like Remicade (infliximab), Humira (adalimumab), Cosentyx (secukinumab), and Tremfya (guselkumab) for more severe cases of psoriasis.

Another option is ultraviolet B (UVB), also known as narrowband phototherapy. This treatment is usually prescribed for children, people who are pregnant or breastfeeding, or people with a weakened immune system.

There’s no cure for psoriasis, but treatments can help manage symptoms like itching, redness, and skin scales. Topical creams are a common first-line treatment for psoriasis.

Psoriasis creams come in OTC and prescription strengths. While OTC creams may be effective for mild cases, prescription-strength options may be necessary for moderate to severe psoriasis.

The type of psoriasis cream best for you depends on various factors, including the severity, location, and type of psoriasis, as well as your response to previous treatments and personal preferences. Your healthcare provider can help you determine the most suitable treatment plan.