Common Eczema And Psoriasis Treatments— and Their Side Effects
Skin conditions like eczema and psoriasis are chronic, which means they require ongoing management to maintain the skin’s balance and integrity. The goal of any type of therapy for eczema or psoriasis is to maximize the asymptomatic period between flares.
“The pharmacology behind treating skin conditions such as eczema and psoriasis is well-established,” says Dr. John Papastergiou, BScPhm, PhD, RPh and Assistant Professor at both the University of Toronto’s Leslie Dan Faculty of Pharmacy and the University of Waterloo’s School of Pharmacy. However, it’s important to understand the different roles various types of medications play, as well as the potential side effects associated with each. “Generally, patients with a chronic skin condition start with the over-the-counter options before progressing to prescription-based treatments as the disease worsens or spreads to cover more of the body,” Dr. Papastergiou adds.
Over-the-counter Therapies
When a skin condition first makes its presence known, most patients are seeking relief from symptoms like dryness, itching and flaking. It’s important to remember that over-the-counter treatments only relieve the symptoms themselves rather than addressing the source of these skin conditions. Although these treatments are available without a prescription, it’s wise to consult with your doctor before adding any OTC drug into your skincare routine.
Bleach baths: Often recommended for eczema patients, soaking in a bath with just a small amount of added bleach, once or twice a week, may help soothe the itching and rash—especially in combination with diligent moisturizer use.
Downsides: Bleach baths can over-dry the skin and be painful if skin is cracked.
Salicylic acid: A common skincare ingredient, salicylic acid helps promote the skin’s natural exfoliation process to help reduce the scaling associated with psoriasis. It may also be used with other topical therapies to enhance their penetration.
Downsides: Salicylic acid is unlikely to provide meaningful improvement on its own. Salicylic acid shampoos for scalp psoriasis may lead to hair damage.
Pramoxine: Found in many over-the-counter eczema lotions and creams, this anesthetic has numbing properties that reduce the sensation of itch.
Downsides: Relief from this anesthetic is temporary.
Hydrocortisone: This very mild steroid can be used to improve itching, irritation and inflammation caused by eczema and psoriasis.
Downsides: Hydrocortisone rarely offers effective, long-term symptom management. It’s essential to follow directions for application frequency to avoid side effects.
Prescription Therapies
Once eczema and psoriasis progress beyond the mild phase and perhaps begin to spread to cover a larger part of the body, prescription-based treatments are often necessary to manage and minimize flare-ups.
Topical steroids: Available in much stronger concentrations by prescription, these treatments relieve itching and inflammation quickly.
Downsides: The potential side effects associated with topical steroids include loss of effectiveness over time (which requires increasing dosage to maintain relief), thinning of the skin with long-term use and Topical Steroid Withdrawal Syndrome.
Topical JAK/calcineurin/PDE4 inhibitors: These well-established treatments come in varying strengths.
- JAK inhibitors: These drugs block the enzymes necessary for transmitting immune signals that trigger skin inflammation, redness and rashes.
Downsides: JAK inhibitors may not be appropriate for long-term, ongoing use or immunocompromised patients.
- Calcineurin inhibitors: Topical calcineurin inhibitors (TCIs) are nonsteroidal medications that work by stopping certain cells of the immune system from “switching on.” TCIs help calm eczema symptoms such as redness and itch and inflammation. These medications also minimize psoriasis flares and reduce scales—especially in areas with thin skin where topical steroids can be too irritating or potentially harmful.
Downsides: In 2006, the FDA implemented a black box warning for TCIs regarding long-term safety and a possible risk of lymphoma (a type of blood cancer).
- PDE4 inhibitors: Designed to block a specific type of enzyme that is involved in the inflammation process, this is one of the newest topical treatments for eczema and psoriasis.
Downsides: A small number of patients have reported burning or stinging after application. Other possible side effects include a worsening of eczema or psoriasis symptoms or skin infection.
Oral antihistamines: Available in higher strengths by prescription (and in lesser strengths over the counter), antihistamines effectively reduce itching. These medications can help if itching associated with flare-ups makes it difficult to sleep.
Downsides: Itch relief is temporary, and these medications do not address the source of inflammation.
Oral immunosuppressants/JAK inhibitors: These oral prescription-based treatments for moderate-to-severe eczema and severe psoriasis target immune system activity that leads to skin inflammation.
Downsides: These drugs may not be safe when pregnant or breastfeeding and may require ongoing testing to monitor blood pressure and kidney function.
Oral steroids: Although a potential treatment option for severe, persistent eczema and psoriasis, the American Academy of Dermatology advises that oral steroid treatment should be exclusively reserved for “acute, severe exacerbations and as a short-term bridge therapy to other systemic, steroid-sparing therapy.”
Downsides: Long-term oral steroid use (i.e., more than one month) has been associated with serious side effects like skin thinning, infections, hair loss, weight gain, high blood pressure, glaucoma, cataracts and more.
Biologics: Delivered via injection, biologics essentially use human DNA to treat certain diseases at the immune system level. These drugs block protein messengers from binding to their cell receptors to stop or limit the immune system’s response. A calmer immune system means lower or less severe inflammation and therefore fewer eczema and psoriasis symptoms.
Downsides: Biologics should be used with caution as they have the potential to suppress the immune system and increase the risk of serious infections.
Systemic medications: These oral and injectable treatments are considered “off label”, which means that they are used to treat eczema and psoriasis despite being FDA-approved for treating other conditions. They are generally used for a short period of time to get eczema and psoriasis under control before tapering off or switching to topical medication for long-term management.
Downsides: These are serious drugs with serious potential for side effects, including infections, certain cancers, kidney damage, high blood pressure and more.
How Phoilex Fits In
Phoilex represents a proven-effective, plant-based approach that works inside and out to restore balance to the skin. Our Active ReLeaf Spot Gel and Liverty Dynamic Drops can be used to calm and soothe the skin on their own, and they are also safe to use in conjunction with other over-the-counter and prescription-based therapies.
Dr. Papastergiou explains, “In many cases, a patient is advised to stop using a particular therapy when a certain level of improvement is achieved. The big question patients have is, what happens between these therapies? During this time, Phoilex works to maximize the asymptomatic period. What we’re seeing is that Phoilex helps increase the time before another course of treatment is necessary.”
Phoilex Active ReLeaf Spot Gel steps in when eczema and psoriasis flare up as well by protecting and drawing moisture to the skin. “The goal of any topical product is to restore integrity to the upper layers of skin, because skin that is more intact will experience less dryness and flaking, and your skin will get better quicker,” says Dr. Papastergiou.
The addition of our Liverty Dynamic Drops allows for a comprehensive, inside-out approach to improving the health and appearance of the skin. This ingestible daily tincture is also formulated with calming CBD to mitigate the negative effects that stress can have on skin conditions. It also works to support the liver so it can perform its essential toxin-filtering functions that help keep inflammation at bay.
Phoilex Active ReLeaf Spot Gel is powered by our proprietary Phyto-Active Blend™ of seven botanicals with powerful antioxidant and anti-inflammatory properties. This unique mix of ingredients has been clinically shown to provide hydrating, healing and soothing benefits when the skin is both calm and experiencing a flare.
Dr. Papastergiou emphasizes, “There are a ton of over-the-counter treatments that claim to do many things, yet very few of them are associated with any scientific evidence. At Phoilex, we’ve made the effort to establish our products’ efficacy, and the benefits are clear.”
