Steroid-Free Treatment Options for Psoriasis

+ Pamela Friedman

The National Psoriasis Foundation (NPF) states that about 8 million people currently have psoriasis, with nearly 60 percent reporting the disease to be a large problem in their everyday lives.

Psoriasis is an autoimmune disease that causes raised, red, scaly patches to appear on the skin. These patches usually affect the elbows, knees, and scalp, but they can affect any area on the body. The patches typically itch, burn, and sting, and they can also be embarrassing, as some people misinterpret the patches as being evidence of a contagious disease (they’re not contagious).

There is no cure, so treatments focus on reducing the symptoms and clearing the skin. The drugs most often prescribed are topical corticosteroids. These are synthetic medications that have potent anti-inflammatory actions, and they can also help suppress the malfunctioning immune system response. These are some of the oldest and most useful treatments, but they do have some downsides.

The main problem with steroids is that they can rarely be used long-term. A short course (4 weeks or less) with a low dose can help clear a flare-up, and side effects are rare. But those with more frequent or severe flare-ups may need higher doses or longer periods of treatment, and that’s when the side effects can become problematic.

Fortunately, there are some steroid-free options available.

Side Effects of Topical Steroids Can Be Problematic

Long-term use of topical steroids—or repeated short-term bursts of stronger steroids—are linked to several difficult side effects:

  • Skin atrophy: Because of a decrease in the quantity of collagen, the skin “thins,” becoming more fragile and translucent.
  • Stinging or burning following the first treatment.
  • Stretch-marks: In some cases, long-term use of topical steroids in areas like the groin and armpits can result in permanent stretch marks.
  • Rosacea: In some cases, the medications may induce rosacea, an unnatural redness and rash-like formation on the skin.
  • Acne: As skin struggles, acne breakouts may become more frequent.
  • Increased hair growth on the area being treated.
  • Allergic reactions: Some people grow allergic to steroids over time.
  • Skin ulcers: Wounds on the skin may erupt in response to steroid use over time.
  • Delayed wound healing: The skin loses its ability to repair itself, which may result in wounds that last longer than usual.

Sometimes, those using topical steroids long-term may suffer from withdrawal or topical steroid addiction. This can result from prolonged, frequent, or inappropriate use of moderate to high potency options. Symptoms include burning, stinging, and bright red skin that occur within days to weeks after discontinuing the use of the steroids.

Steroid-Free Psoriasis Treatments

Because of the dangerous side effects associated with long-term use of topical steroids, many of those with psoriasis would prefer alternative treatments. It’s always best to talk to your dermatologist, then consider these options:

1. Topical Vitamin D

Studies have shown that people with psoriasis are often low in vitamin D. This vitamin plays a role in cell turnover in the skin, which caused scientists to wonder if it might help people with psoriasis—in which dead skin cells build up too quickly on the surface of the skin.

According to a 2017 study, it’s still unclear whether treatment with either topical or oral vitamin D supplementation is effective, but since the vitamin affects both skin biology and regulation of the immune system, it makes sense that it would be helpful.

We do have some evidence that vitamin D oil applied directly to a psoriasis flare can help thin the plaque, while oral supplements of 400 to 1,000 IUs a day may also provide benefits.

2. Salicylic Acid

This gentle acid can help promote the shedding of dead skin cells, reducing scaling. It can be combined with other treatments like coal tar to increase effectiveness. It’s also available in some shampoos to treat scalp psoriasis.

DIY tip for scalp psoriasis: Crush two aspirin tablets (which contain salicylic acid) and add to your regular shampoo when you wash your hair. Let sit for two minutes before rinsing.

3. Topical Retinoids

These are forms of vitamin A that may help decrease inflammation. They come in creams or gels at various concentrations, and can also help maintain skin therapy between flare-ups.

Some studies have found that retinoids can be more effective than corticosteroids, but skin irritation is possible. These also increase skin sensitivity to sunlight, so it’s important to protect the skin from the sun while using them.

4. Light Therapy (Phototherapy)

This treatment uses natural or artificial ultraviolet light to help slow skin cell turnover, reduce scaling, and tame inflammation. If using real sunlight, it’s best to go with brief, daily exposures to small amounts of sun, as intense exposure can make the symptoms worse.

You can also use an artificial light source—usually called UVB phototherapy—to treat single patches or widespread psoriasis that isn’t responding to other treatments. Side effects may include redness, itching, and dry skin, so it’s best to use a moisturizer after each treatment to help reduce these effects. (Our Calming Moisture and Body Repair Lotion are great fragrance-free options!)

5. Turmeric

Turmeric is a spice often used in Eastern cuisine that has been found over recent years to have several health benefits. It contains an active component called curcumin that is not only a powerful anti-inflammatory, but may help treat psoriasis, specifically.

Several studies have shown turmeric’s promise as a psoriasis treatment. In those examining topical application, results showed that symptoms improved significantly, with participants reporting a higher quality of life. In one 2011 study of nearly 650 people, those using a curcumin gel to treat psoriasis lesions reported a significant reduction in symptoms after 16 weeks, with symptoms disappearing completely in nearly three-quarters of them.

There is also some evidence that oral supplementation with turmeric may help people with psoriasis, but those studies showed little benefit, so for now, it seems as if topical application is the best approach.

Note: All CV Skinlabs products contain our propriety Tri-Rescue Complex, which includes turmeric as one of three key anti-inflammatory ingredients.

6. Coal Tar (But We Warn You…)

People have used coal tar to treat psoriasis for years, but we hesitate to recommend it because of some evidence linking it to skin cancer.

Coal tar is a product derived from coal that can help slow the rapid growth of skin cells and restore skin’s appearance. It can also help reduce inflammation, itching, and scaling. According to a 2010 review, it was found to be effective in the treatment of psoriasis with few side effects. It’s commonly used to treat scalp psoriasis and can be found in some therapeutic shampoos.

Warning: There is concern about coal tar and risk of skin cancer. Animal studies where the animals were exposed to much more coal tar than used to treat psoriasis, and occupational studies where people worked with industrial coal tar (different from coal tar skin products), did show a potential link to skin cancer. Studies with coal products prescribed to treat psoriasis or atopic dermatitis, however, have not shown any such increased risk.

The American Academy of Dermatology states that dermatologists have been prescribing coal tar for more than 100 years to treat psoriasis, and it is considered safe for long-term use.

We recommend you avoid this solution unless you’re really struggling with psoriasis symptoms. In that case, talk to your dermatologist. Some people also experience reactions to coal tar, including redness and dryness, so it may be best to try some on a small area first. You can also mix the tar with a moisturizer before applying.

Tar can stain clothing, so use it with caution, and make sure you protect your skin from the sun, as it can increase sensitivity to UV rays.

Natural Ingredients that Can Help Sooth Psoriasis Symptoms

While you’re working with your dermatologist to find the best treatment for your psoriasis, you may also want to look into products containing the following ingredients, which can all help relieve itching, burning, and redness, while keeping skin moisturized.

1. Natural Moisturizers

It’s critical to prevent dryness when you’re dealing with psoriasis, so look for those ingredients known to help moisturize, hydrate, and secure the skin’s barrier function so it’s less likely to lose the moisture it has. Good options include:

  • Aloe vera is extremely soothing and helps tame redness.
  • Castor oil and other natural oils like jojoba, coconut, and argan help seal in moisture.
  • Shea butter and other natural butters help lock in moisture.

2. Natural Anti-Inflammatories

Inflammation is another key process involved in creating psoriasis plaques. You can keep inflammation low on your skin by regularly using products that contain the following ingredients:

  • Turmeric has a powerful natural anti-inflammatory action, and may be particularly helpful in treating psoriasis. It helps inhibit the action of tumor necrosis factor-alpha and interleukin, both of which trigger inflammation. In fact, some of the medications used to treat psoriasis target these same proteins. Turmeric also has immunomodulatory properties that help tame the overactivity of the immune cells that characterize the disease.
  • Tea tree oil is also a natural anti-inflammatory, but test it on a small area of skin first to be sure you’re not sensitive to it. To use, mix one part tea tree oil to 10 parts of your favorite carrier oil, like olive oil, or mix a few drops of tea tree with your shampoo.

3. Natural Anti-Itch Products

Oh, if only you could get rid of that itch! Try these ingredients:

  • Beta glucan (oat extract): it helps quell itchiness and inflammation.
  • Straight oatmeal: Crush it finely and add it to your bath, or package it in some hose first to avoid the soggy mess.
  • Apple cider vinegar: As long as you dilute it correctly, it works as an anti-itch remedy. Mix one part apple cider to two parts water, dab on skin, then rinse after 10 minutes. Don’t use on areas that are cracked or bleeding.
  • Dead sea salts: Also called Epsom salts, these can help ease itching. Use in a warm bath or soak the itchy skin in a mix of warm water and salt.

Do you treat your psoriasis without steroids?

Barrea, Luigi, Maria C. Savanelli, Carolina Di Somma, Maddalena Napolitano, Matteo Megna, Annamaria Colao, and Silvia Savastano. “Vitamin D and its role in psoriasis: An overview of the dermatologist and nutritionist.” Reviews in Endocrine and Metabolic Disorders 18, no. 2 (2017), 195-205. doi:10.1007/s11154-017-9411-6.

Slutsky, J. B. “An evidence-based review of the efficacy of coal tar preparations in the treatment of psoriasis and atopic dermatitis.” J Drugs Dermatol. 9, no. 10 (October 2010), 1258-64.

Torsekar, R. “Topical Therapies in Psoriasis.” Indian Dermatol Online J 8, no. 4 (July/August 2017), 235–245. doi:10.4103/2229-5178.209622.

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