Topical Medications for Pustular Psoriasis

The medications used to treat the general plaque variety of psoriasis are also used to treat pustular psoriasis. These medications include:



Vitamin D: There are various types medications derived from Vitamin D. These products have the ability to decrease the excess production of cells that is so common in psoriasis. These drugs are useful for moderate to severe pustular psoriasis and need to be applied twice a day to be effective. Individual who have high calcium levels or allergy to vitamin D products should not use calcipotriene. Calcipotriene should not be used in combination with aspirin like drugs (NSAIDs) as it is inactivated. The drug should not be applied on the eyes, nose or mouth. The drug can cause skin irritation and should be applied sparingly. It is expensive.

Coal tar: Coal tar is a mixture of many different chemicals and is extracted from coal. The coal tar is usually applied during the day and not covered by any dressing. Coal tar products are available in many formulations including shampoos, soaps, oils, ointments and creams. The tar can decrease the pustules. Tar therapy is often combined with UV light therapy for more effectiveness. It is applied as a thin paste and then removed within 5 minutes. The body should be thoroughly washed after application of the coal tar. Besides having an offensive smell, the coal tar is sticky, stains clothes and bed sheets. When left for long periods on the skin, it can produce skin irritation.

Corticosteroids: There are various topical steroids available today. The lighter strength corticosteroids are also available without a prescription. These medications can stop the itch and reduce the inflammation. Topical corticosteroids are meant to treat acute episode of pustular psoriasis. When the psoriasis is quiet, topical steroids are not indicated.

Tree bark extract: Tree Bark extracts such as (Dithranol) are very effective in the treatment of pustular psoriasis. These extracts are widely used in hospitals and for outpatient treatments. The tree bark preparations can cause skin irritation and also stain clothes. The extract is only applied sparingly and never used on the eyes, nose or mouth. Those individuals who have Anthralin allergy should not use tree bark products. Anthralin should only be applied for less than 20 minutes and then washed out. Prolonged use can lead to a severe skin rash.

Calcineurin inhibitors: Today we also have newer agents like tacrolimus and pimecrolimus. These agents can be applied on the skin and are useful for pustular psoriasis. Unlike the corticosteroids, they have fewer side effects. The drugs suppress the immune system and prevent the worsening of the psoriasis. Unfortunately, these drugs are also expensive.



Topical Retinoids: Topical Retinoids can also be used in the treatment of pustular psoriasis. Tazarotene (Tazorac) is a topical retinoid that is available as a gel or cream. Tazorac can decrease the skin irritation, pain and itch of pustular psoriasis. Topical Retinoids are frequently combined with corticosteroids. These agents can be applied on most parts of the body. The Retinoids are expensive and should only be applied as a thin paste. In some individuals, these drugs can also cause skin irritation. Females of child bearing age should be aware that these drugs can cause damage to a fetus and use of this drug should be discussed with the physician. After application of the topical Retinoids, sun exposure should be avoided.