Topical medications effective for psoriasis available by prescription include those that contain topical steroids of various potencies. Typical steroid medications are halcinonide ( Halog , Halog-E ), flurandrenolide ( Cordran , Cordran SP , Cordran Tape ), betamethasone ( Luxiq ), desonide ( Desonate ), alclometasone ( Aclovate ), mometasone ( Elocon ), fluocinonide ( Vanos ), and triamcinolone acetonide ( Kenalog ). Tar-containing topicals and vitamin D -like molecules (calcipotriol [ Taclonex ]/calcipotriene [ Dovonex ]) also can be helpful. Ultraviolet light administered under controlled conditions in a physician's office in various wavelengths (narrow-band UVB) with or without supplemental medication (8-methoxypsoralen) ( PUVA treatment) is a very effective therapy. Systemic therapies include a vitamin A -like drug, acitretin ( Soriatane ), short-term cyclosporine ( Gengraf , Neoral , Sandimmune ) therapy for severe flares, and methotrexate ( Rheumatrex Dose Pack , Trexall ). A new oral drug, apremilast (Otezla), has recently become available that seems to work best for mild to moderate psoriasis. New and expensive targeted drugs called biologics, which include etanercept ( Enbrel ), adalimumab ( Humira ), infliximab ( Remicade ), ustekinumab ( Stelara ), secukinumab (Cosentyx), and ixekizumab (Taltz), are now available. These newer products are produced by new technologies requiring their synthesis by living cells. They are proteins and all currently must be given by injection at various intervals into the subcutaneous tissue by the patient or by intravenous infusion in a medical facility. They are unique in that they have precise targets in the in the inflammatory pathway that they block. Since the biologics are very, very specific in their mode of action, they claim to offer increased safety and improved efficacy over older less specific immunosuppressive drugs.
The extent of percutaneous absorption of topical corticosteroids is determined by many factors, including product formulation and the integrity of the epidermal barrier. Occlusion , inflammation and/or other disease processes in the skin may also increase percutaneous absorption. Once absorbed through the skin, topical corticosteroids are handled through pharmacokinetic pathways similar to systemically administered corticosteroids. They are metabolized primarily in the liver and then are excreted by the kidneys. Some corticosteroids and their metabolites are also excreted in the bile .
There are few complications attributable to this condition. Most problems seem to be related to misdiagnosis or mistreatment. Rarely, certain superficial cutaneous (dermatophyte) fungal infections of the face and scalp can resemble seborrheic dermatitis. If dermatophyte infections are mistakenly treated with anti-inflammatory medications (topical steroids), more extensive involvement could be encouraged. The overuse of potent topical steroids in an ill-conceived attempt to cure this condition, especially on the face and armpits, can result in many undesirable skin changes including skin thinning. Severe seborrheic dermatitis can occasionally produce thinning or loss of hair, in great part probably related to excessive scratching. As the disease is controlled, regrowth is expected.