Editing Psoriasis (section)

===Topical agents===
Topical [[corticosteroid]] preparations are the most effective agents when used continuously for eight weeks; [[retinoid]]s and [[coal tar]] were found to be of limited benefit and may be no better than [[placebo]].<ref name="Samarasekera2013">{{cite journal | vauthors = Samarasekera EJ, Sawyer L, Wonderling D, Tucker R, Smith CH | title = Topical therapies for the treatment of plaque psoriasis: systematic review and network meta-analyses | journal = The British Journal of Dermatology | volume = 168 | issue = 5 | pages = 954–967 | date = May 2013 | pmid = 23413913 | doi = 10.1111/bjd.12276 | s2cid = 21979785 }}</ref> Very potent topical corticosteroids may be helpful in some cases, however, it is suggested to only use them for four weeks at a time and only if other less potent topical treatment options are not working.<ref>{{cite journal | vauthors = Kleyn EC, Morsman E, Griffin L, Wu JJ, Cm van de Kerkhof P, Gulliver W, van der Walt JM, Iversen L | title = Review of international psoriasis guidelines for the treatment of psoriasis: recommendations for topical corticosteroid treatments | journal = The Journal of Dermatological Treatment | volume = 30 | issue = 4 | pages = 311–319 | date = June 2019 | pmid = 31138038 | doi = 10.1080/09546634.2019.1620502 | s2cid = 169036303 | doi-access = free }}</ref>

[[Vitamin D analogue]]s (such as [[paricalcitol]], [[calcipotriol]], [[tacalcitol]], and [[calcitriol]]) are superior to placebo. Combination therapy with vitamin D and a corticosteroid is superior to either treatment alone and [[vitamin D]] is superior to coal tar for chronic plaque psoriasis.<ref name="Mason2013">{{cite journal | vauthors = Mason AR, Mason J, Cork M, Dooley G, Hancock H | title = Topical treatments for chronic plaque psoriasis | journal = The Cochrane Database of Systematic Reviews | issue = 3 | pages = CD005028 | date = March 2013 | volume = 2015 | pmid = 23543539 | doi = 10.1002/14651858.CD005028.pub3 | pmc = 11227123 | url = http://dro.dur.ac.uk/20582/1/20582.pdf | id = CD005028 | access-date = 6 November 2019 | archive-date = 28 April 2021 | archive-url = https://web.archive.org/web/20210428101001/https://dro.dur.ac.uk/20582/1/20582.pdf | url-status = live }}</ref>

For psoriasis of the scalp, a 2016 review found dual therapy (vitamin D analogs and topical corticosteroids) or corticosteroid monotherapy to be more effective and safer than topical vitamin D analogs alone.<ref name=Schlager2016>{{cite journal | vauthors = Schlager JG, Rosumeck S, Werner RN, Jacobs A, Schmitt J, Schlager C, Nast A | title = Topical treatments for scalp psoriasis | journal = The Cochrane Database of Systematic Reviews | volume = 2016 | issue = 2 | pages = CD009687 | date = February 2016 | pmid = 26915340 | doi = 10.1002/14651858.CD009687.pub2 | pmc = 8697570 | id = CD009687 }}</ref> Due to their similar safety profiles and minimal benefit of dual therapy over monotherapy, corticosteroid monotherapy appears to be an acceptable treatment for short-term treatment.<ref name=Schlager2016 />

[[Moisturizer]]s and emollients such as [[mineral oil]], [[petroleum jelly]], and [[decubal]] (an oil-in-water emollient) were found to increase the clearance of psoriatic plaques. Some emollients are even more effective at clearing psoriatic plaques when combined with [[Light therapy|phototherapy]].<ref name="Asztalos2013">{{cite journal | vauthors = Asztalos ML, Heller MM, Lee ES, Koo J | title = The impact of emollients on phototherapy: a review | journal = Journal of the American Academy of Dermatology | volume = 68 | issue = 5 | pages = 817–24 | date = May 2013 | pmid = 23399460 | doi = 10.1016/j.jaad.2012.05.034 | url = https://zenodo.org/record/897997 | access-date = 30 June 2019 | archive-date = 29 August 2021 | archive-url = https://web.archive.org/web/20210829015357/https://zenodo.org/record/897997/preview/article.pdf | url-status = live }}</ref> Certain emollients, though, have no impact on psoriasis plaque clearance or may even decrease the clearance achieved with phototherapy, e.g. the emollient [[salicylic acid]] is structurally similar to [[para-aminobenzoic acid]], commonly found in [[sunscreen]], and is known to interfere with phototherapy in psoriasis. [[Coconut oil]], when used as an emollient in psoriasis, has been found to decrease plaque clearance with phototherapy.<ref name="Asztalos2013"/> Medicated creams and ointments applied directly to psoriatic plaques can help reduce inflammation, remove built-up scale, reduce skin turnover, and clear affected skin of plaques. Ointment and creams containing coal tar, [[dithranol]], corticosteroids (i.e. [[desoximetasone]]), [[fluocinonide]], vitamin D<sub>3</sub> analogues (for example, calcipotriol), and [[retinoid]]s are routinely used. (The use of the [[finger tip unit]] may be helpful in guiding how much topical treatment to use.)<ref name="Clarke2011"/><ref>{{cite journal | vauthors = Menter A, Korman NJ, Elmets CA, Feldman SR, Gelfand JM, Gordon KB, Gottlieb A, Koo JY, Lebwohl M, Lim HW, Van Voorhees AS, Beutner KR, Bhushan R | title = Guidelines of care for the management of psoriasis and psoriatic arthritis. Section 3. Guidelines of care for the management and treatment of psoriasis with topical therapies | journal = Journal of the American Academy of Dermatology | volume = 60 | issue = 4 | pages = 643–59 | date = April 2009 | pmid = 19217694 | doi = 10.1016/j.jaad.2008.12.032 }}</ref>

Vitamin D analogs may be useful with [[steroid]]s; steroids alone have a higher rate of side effects.<ref name="Mason2013" /> Vitamin D analogs may allow lower doses of steroids to be used.<ref>{{cite journal | vauthors = Soleymani T, Hung T, Soung J | title = The role of vitamin D in psoriasis: a review | journal = International Journal of Dermatology | volume = 54 | issue = 4 | pages = 383–92 | date = April 2015 | pmid = 25601579 | doi = 10.1111/ijd.12790 | s2cid = 1688553 }}</ref>

Another topical therapy used to treat psoriasis is a form of [[balneotherapy]], which involves daily baths in [[Saline water|saltwater]], such as the [[Dead Sea]], combined with sun exposure. This is usually done for four weeks in which exposure time is gradually increased. The primary benefit is attributed to sun exposure and specifically [[UVB]] light. This is cost-effective and it has been propagated as an effective way to treat psoriasis without medication.<ref name="Halverstam2008">{{cite journal | vauthors = Halverstam CP, Lebwohl M | title = Nonstandard and off-label therapies for psoriasis | journal = Clinics in Dermatology | volume = 26 | issue = 5 | pages = 546–53 | date = September–October 2008 | pmid = 18755374 | doi = 10.1016/j.clindermatol.2007.10.023 }}</ref> Decreases of PASI scores greater than 75% and [[Remission (medicine)|remission]] for several months have commonly been observed.<ref name="Halverstam2008"/> Side effects may be mild such as itchiness, [[folliculitis]], [[sunburn]], [[poikiloderma]], and a theoretical risk of nonmelanoma cancer or melanoma has been suggested.<ref name="Halverstam2008"/> Some studies indicate no increased risk of melanoma in the long term.<ref name="Katz2012"/> Data are inconclusive concerning nonmelanoma skin cancer risk, but support the idea that the therapy is associated with an increased risk of benign forms of sun-induced skin damage such as, but not limited to, [[actinic elastosis]] or [[solar lentigines|liver spots]].<ref name="Katz2012">{{cite journal | vauthors = Katz U, Shoenfeld Y, Zakin V, Sherer Y, Sukenik S | title = Scientific evidence of the therapeutic effects of dead sea treatments: a systematic review | journal = Seminars in Arthritis and Rheumatism | volume = 42 | issue = 2 | pages = 186–200 | date = October 2012 | pmid = 22503590 | doi = 10.1016/j.semarthrit.2012.02.006 }}</ref> Dead Sea balneotherapy is also effective for psoriatic arthritis.<ref name="Katz2012"/> Tentative evidence indicates that balneophototherapy, a combination of [[balneotherapy|salt bath]]es and exposure to [[ultraviolet]] B-light (UVB), in chronic plaque psoriasis is better than UVB alone.<ref>{{cite journal | vauthors = Peinemann F, Harari M, Peternel S, Chan T, Chan D, Labeit AM, Gambichler T | title = Indoor salt water baths followed by artificial ultraviolet B light for chronic plaque psoriasis | journal = The Cochrane Database of Systematic Reviews | volume = 2020 | issue = 5 | pages = CD011941 | date = May 2020 | pmid = 32368795 | doi = 10.1002/14651858.CD011941.pub2| pmc = 7199317 }}</ref> [[Glycerin]] is also an effective treatment for Psoriasis.<ref>Medical College of Georgia at Augusta University. "Glycerin is safe, effective in psoriasis model." ScienceDaily. [www.sciencedaily.com/releases/2021/10/211004104229.htm] (accessed 9 July 2023).</ref>