Topical treatments (and the Finger Tip Unit measure)
A topical medication is one used externally, applied directly to the skin. The treatment which is typically a cream or an ointment is applied locally on the affected site.
Topical treatments are first line treatments, meaning that these treatments are usually tried before systemic treatments can come into play.
The Finger Tip Unit (FTU) is the keystone in how to apply a topical treatment correctly. The FTU is a simple, individual measure telling you how much cream or ointment to apply to a psoriasis lesion. A FTU is the amount of ointment or cream covering the distance from the tip of the your index finger to the first joint as the preparation is squeezed out of the tube -see picture below. One FTU will be sufficient to cover a body area of 2 hands. Thus 2 FTU's will be sufficient to cover a body area of 4 hands.

Please find further details about the different topical treatment options below.
Calcipotriol and betamethasone combination
A new treatment in the form of a combination of a vitamin D3 analogue and a corticosteroid is available.
Should be applied once daily and is proven to be fast acting and effective. Most patients will be cleared within 4 weeks treatment.
Side effects are few. In a long-term safety study it was concluded that the product is well tolerated. Side effects are the same as for calcipotriol, although skin irritation is significantly less.
Aimed for people with mild, moderate or severe psoriasis vulgaris, where no more than 30% of the body surface area is affected.
Only available as an ointment.
Calcipotriol
Calcipotriol is a vitamin D3 analogue for psoriasis vulgaris. The mode of action is not fully understood, but it is believed that calcipotriol works by slowing down the hyperproliferation of keratinocytes and immunologic changes in the psoriatic skin.
Should be applied twice daily and Approx. 70% of patients will be clear or almost clear after 8 weeks treatment.
The most frequent side-effects are burning, itching and skin irritation, which occur in about 10-15% of patients.
Coal tar
This form of treatment is very old, but still found in shampoos for mild scalp psoriasis as well as in intensive hospital regimens.
The exact mechanism of action is unknown, but coal tar makes skin more sensitive to light and can help slow down the rapid proliferation of keratinocytes. Tar also helps reduce the inflammation, itching and scaling of the skin.
Improvement is often seen in a few weeks, but it can take up to 2 months to achieve maximum benefits.
Coal tar contains more than 10.000 ingredients, of which only about 50% have been identified, and there can be a wide difference in the formulations available.
Corticosteroids (also called steroids)
Corticosteroids and steroids are often used for mild-to-moderate psoriasis. Steroids are fast acting, but safety of long-term treatment has not been studied.
Over-the-counter steroids are (in most countries) too weak to be effective on psoriasis.
Moisturizers, bath and shower oils
Moisturizers, bath and shower oils can moisture the skin and help the skin to heal as well as help to maintain the skin clear and free from psoriasis.
Can be bought over the counter in many different formulations and brands.
Salicylic acid
Salicylic acid is often combined with other topical products to enhance its effect. It is found in shampoos, soaps, lotions and gels and is a keratolytic i.e. it is primarily effective for removing scales. Salicylic acid has little therapeutical effect on the psoriatic lesion itself.
Available in many different strengths. Stronger preparations can irritate the skin if left on too long.
Tazarotene
Tazarotene is a topical retinoid which is used to treat mild-to-moderate plaque psoriasis. It is a prescription vitamin A derivative, which works by slowing down the hyperprofilation of keratinocytes.
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