How Are Retinoids Used in Psoriasis Treatment?

Corticosteroids, biologics, light therapy, immunosuppressive medications — treatment for psoriasis has come a long way, providing different ways to manage the autoimmune skin condition depending on its type, severity, and location.

They can be prescribed in topical or oral form, and each is used in different situations and with different risks. Here’s what to know about prescription retinoids and whether over-the-counter (OTC) retinol belongs in your skin-care routine if you have psoriasis.

What Are Retinoids?

And they’re a tool for treating psoriasis, according to Joseph Lam, MD, a pediatric dermatologist at the BC Children’s Hospital in Vancouver, British Columbia, who is a spokesperson for the Society for Pediatric Dermatology.

Retinoids “help with psoriasis by stopping skin cells from dividing too fast. They also help calm down the immune system,” Dr. Lam says.

Prescription Topical Retinoids

“Tazarotene is a fairly powerful retinoid. It works like all retinoids do — by stopping skin cells from dividing too fast and calming down the immune system,” he says.

Dermatologists often pair tazarotene with a topical corticosteroid, says Marisa Garshick, MD, a dermatologist in New York and New Jersey and a clinical assistant professor of dermatology at NewYork-Presbyterian Weill Cornell Medicine.

Tazarotene isn’t for everyone, though. “It can be considered for patients with thick, stubborn, scaly psoriasis plaques that aren’t responding to topical steroid treatment alone,” Dr. Garshick says.

It’s also saved for people with limited disease, Lam says. “If lots of skin is involved, it’s not practical to put all over,” he says.

You can ease your way into using tazarotene by starting with a lower concentration, applying the ointment every other day, or using a cream instead of gel if you have sensitive skin, Lam says. Stay away from layering it with retinols, abrasive soaps and detergents, and products with a high alcohol content, he says.

If tazarotene is causing significant irritation, or if the treated skin is sunburned, speak with your dermatologist before changing how you use it, Lam says.

Some people see improvements as early as within a week, Lam says. “The best results are seen after about two to three months of use,” he says.

Prescription Systemic Retinoids

“Acitretin is typically reserved for more extensive or difficult to treat psoriasis, including pustular or erythrodermic psoriasis,” Garshick says.

But in most cases, if patients have extensive psoriasis, biologics are the “preferred treatment,” Lam says. Because biologics are the most common systemic treatment that dermatologists prescribe, acitretin is usually earmarked for pustular psoriasis, Garshick says.

• Hair loss
• Dry skin and eyes
• Chapped lips and dry mouth
• Increased sensitivity to sunlight
• Brittle nails
• Burning or sticky feeling on your skin

• You’re pregnant, planning to become pregnant, or breastfeeding
• Have severe liver or kidney disease
• Have high triglycerides (a type of fat) in the blood

What About Over-the-Counter Retinols?

They aren’t treatments for psoriasis and should not replace prescription medications, Lam says. “OTC retinols are not contraindicated in psoriasis, but they have no proven efficacy for treating psoriatic plaques and carry a risk of local irritation that could theoretically trigger or worsen psoriasis,” he says.

They may have a place in your skin-care routine to treat cosmetic concerns like fine lines as long as your psoriasis is well controlled and the product isn’t being applied to active plaques or irritated skin, Garshick says.

If you’re unsure if a retinol is safe for your psoriasis-prone skin, speak to your dermatologist, Garshick says.