While we might all be curious about the best plunger or probiotic tampon or cold-sore remedy, it can be difficult to discuss these more personal items. That’s why we’re tackling Things We Don’t Talk About, a series in which we track down the best hygiene-, sex-, and bodily function–related things we all need but might be too embarrassed to ask about. In this installment, we consult experts on the best over-the-counter treatments for psoriasis.
Psoriasis can be a struggle for the 2 percent of the population that has it: It’s not your typical skin disorder, but an autoimmune disease that causes certain areas of skin on the scalp, body, and face to produce new skin cells more rapidly than normal — you’ll know it by the scaly, red patches of skin that can clear up and reappear over time. There’s currently no cure, but there are known triggers: medications like lithium, cold weather, and stress are a few. More severe cases may need phototherapy and prescription-strength steroids, while others may benefit from topical treatments that can moisturize and soothe skin. Here, two psoriasis specialists tell us the latest on the over-the-counter treatments that might help (which we’ve cross-referenced with a list of products endorsed by the National Psoriasis Foundation). We’ve organized this list by active ingredients, which is how dermatologists tackle the problem.
Topping the list are tar-based products — one of the two ingredients that has been FDA-approved as a psoriasis treatment, besides salicylic acid. They’re typically very messy, but they work. “We’ve known they’ve been effective for decades, but only recently have we discovered that tar components bind and activate specific receptors in cells that calm down inflammation (psoriasis is a form of inflammation),” says Steven Feldman, a dermatologist and psoriasis expert who sits on the National Psoriasis Foundation Medical Board. One of the most popular tar products for psoriasis (that’s been recognized by the NPF) is this T/Gel shampoo with a small percentage of coal tar in it.
But generally, the higher the concentration of tar, the more potent, says dermatologist Mark Lebwohl, a preeminent psoriasis expert who is chairman of the National Psoriasis Foundation Medical Board and chair of the Department of Dermatology for the Mount Sinai Health System. This shampoo contains 5 percent coal tar — the highest amount that’s FDA approved to be safe for psoriasis.
If you have psoriasis on your body, there are even medicated tar ointments out there that are specifically catered to relieving itching and flaking, like this MG217 product that reviewers call a “miracle product” for psoriasis. If you’re applying it on the body, though, keep in mind that it can stain clothing, linens, and even hair if you’re not careful.
Lebwohl points out that there’s a new range of moisturizers out there that have salicylic acid in them as an active ingredient, another FDA-approved psoriasis treatment. In fact, almost all of the moisturizers currently recognized by the National Psoriasis Foundation contain a percentage of the exfoliant because they work as keratolytics, or “scale lifters,” to remove the buildup of scales or plaques on the body. “It’s not going to do well for severe disease, but is quite beneficial for mild cases,” Lebwohl says.
Even salicylic-acid shampoos can be helpful for exfoliation if you have a buildup of flakes on your scalp, like this Neutrogena T/Sal shampoo that’s on the NPF’s list of psoriasis products.
Besides tar and salicylic acid, the ingredient that Lebwohl recommends the most is zinc pyrithione (which is found in dandruff shampoos like Head & Shoulders, or concentrated versions like the one below). It has antibacterial properties, and beyond dandruff, it is often used for treating seborrhoeic dermatitis.
And while strong prescription-strength cortisone medications are going to be much more effective at reducing inflammation, milder versions with one percent hydrocortisone can be helpful (“especially for psoriasis on sensitive areas like the face or genitals,” says Feldman). Hydrocortisone ointment, rather than a cream, is preferred by experts because it’s thicker, though some may find it too greasy.
Because keeping skin moisturized can neutralize redness and itching, a thicker cream or ointment with ample ceramides to restore the skin barrier (even a greasier Vaseline) can come in handy, too — the NPF recommends looking for fragrance-free products. Something with a ceramide complex like this Curél moisturizer would be a safe option: It’s another product recognized by the NPF that doesn’t contain any fragrance.
Another ingredient that often comes up anecdotally among psoriasis sufferers is tea-tree oil for easing redness and itch. “The National Psoriasis Foundation has a bulletin that goes out to patients and there are countless letters from patients that say it works for them,” says Lebwohl. He adds that the oil has never been shown to work in clinical studies, though “if it works for someone, they should use it.”
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