What home treatments are recommended for mild psoriasis and eczema?

Home Treatment for Mild Psoriasis and Eczema

First-Line Topical Therapy for Psoriasis

For mild to moderate psoriasis, start with a combination of calcipotriene (vitamin D analogue) and a mid- to high-potency topical corticosteroid, which provides superior efficacy compared to either agent alone. 1

Recommended Regimens:

• Fixed combination products: Apply calcipotriene/betamethasone dipropionate once daily for 4-12 weeks 1, 2
• Alternating schedule: Apply vitamin D analogue twice daily on weekdays, combined with high-potency topical corticosteroid twice daily on weekends for maintenance 1
• Split dosing: Apply high-potency topical corticosteroid in the morning and vitamin D analogue in the evening 1

Essential Precautions:

• Never combine calcipotriene with salicylic acid - the acidic pH inactivates calcipotriene and eliminates its effectiveness 1, 3
• Apply calcipotriene after phototherapy sessions if using both, as UVA radiation decreases calcipotriene concentration 1, 3
• Long-term use of vitamin D analogues is safe for up to 52 weeks 1

Moisturizers and Emollients

Apply emollients in conjunction with topical corticosteroids for 4-8 weeks to reduce itching, scaling, and body surface area involvement, and to prevent rapid relapse when corticosteroids are discontinued. 1

• Apply moisturizers after calcipotriene/corticosteroid combination to avoid washing off active medication 1
• Emollients are safe during pregnancy and lactation 1
• Risk of contact dermatitis is minimal unless hypersensitivity to ingredients exists 1

Alternative Topical Options

Coal Tar Preparations:

• Use crude coal tar 0.5-1% in petroleum jelly, increasing to maximum 10% concentration as tolerated 1
• Apply for 8-12 weeks for mild to moderate psoriasis 1
• Caution: Causes staining of skin and clothing, has tar odor, and may cause photosensitivity 1
• Avoid during pregnancy and lactation due to potential fetal effects 1

Anthralin (Dithranol):

• Start at 0.1% concentration, increasing in doubling concentrations as tolerated 1
• Use short-contact method: Apply for up to 2 hours once daily, then wash off to minimize irritation and staining 1
• Avoid on face, flexures, and genitalia due to high irritancy 1
• Apply for 8-12 weeks 1

Tazarotene (Retinoid):

• Apply 0.05-0.1% gel or cream once daily for 8-12 weeks 1
• Always combine with mid- to high-potency topical corticosteroid to reduce irritation and increase efficacy 1
• Contraindicated in pregnancy - obtain negative pregnancy test 2 weeks before starting in women of childbearing age 1

Specific Site Management

Scalp Psoriasis:

• Use calcipotriene foam or calcipotriene/betamethasone dipropionate gel for 4-12 weeks 1
• Alternative: Coal tar shampoos or solutions 4

Facial/Flexural Psoriasis:

• Use calcipotriene combined with hydrocortisone (low-potency corticosteroid) for 8 weeks 1
• Alternative: Tacrolimus or pimecrolimus (off-label) 4
• Avoid anthralin and high-potency corticosteroids on face 1

Nail Psoriasis:

• Apply calcipotriene/betamethasone dipropionate to reduce nail thickness, hyperkeratosis, and onycholysis 1, 5
• Alternative: Tazarotene 0.1% cream under occlusion 5
• Note: Topical treatments have limited penetration for severe nail disease 5

Home Treatment for Eczema

For mild eczema, hydrocortisone (low-potency topical corticosteroid) temporarily relieves itching, inflammation, and rashes. 6

Application Guidelines:

• Apply to affected areas as directed for eczema-related itching and inflammation 6
• Use emollients liberally and frequently to maintain skin barrier 1
• For moderate eczema in adults and children ≥2 years: Consider pimecrolimus 1% cream twice daily to affected areas 7

Pimecrolimus (Elidel) Specific Instructions:

• Use only on areas with active eczema, not as preventive therapy 7
• Apply thin layer twice daily; stop when symptoms resolve 7
• Do not use continuously long-term due to theoretical cancer risk 7
• Contraindicated in children under 2 years 7
• Avoid sun exposure, tanning beds, and UV therapy during treatment 7
• Wash hands after application unless treating hands 7

Adjunctive Stress Reduction

• Meditation and mindfulness can improve psoriasis severity in some patients and should be discussed as adjunctive therapy 1
• Biofeedback and progressive relaxation techniques may benefit patients with mild psoriasis 1
• Hypnosis can be incorporated for highly hypnotizable patients with mild to moderate psoriasis 1

When to Escalate Care

Contact your physician if:

• Symptoms worsen or do not improve after 6 weeks of topical treatment 7
• Skin infection develops 7
• Severe burning persists beyond 1 week with any topical agent 7
• Body surface area involvement exceeds 10% (approximately size of 10 palms) 1