Is Aquaphor Suitable for Psoriasis?
Yes, Aquaphor (petrolatum) is safe and appropriate as a basic emollient for psoriasis, though it provides only symptomatic relief of dryness and scaling without treating the underlying disease. It should be used as an adjunct to active topical therapies like coal tar or dithranol, not as monotherapy for disease control.
Role as Vehicle and Moisturizer
- Petrolatum serves as the standard vehicle for active psoriasis medications, including crude coal tar (0.5-10% in petrolatum) and dithranol preparations, which are considered first-line topical agents 1.
- White petrolatum combined with UV phototherapy has demonstrated efficacy in clearing psoriatic plaques in outpatient settings, with all 26 patients in one study achieving clearance in an average of 27 treatments 2.
- When used with UV-B phototherapy three times weekly, white petrolatum as the sole topical agent resulted in complete clearance in 18 of 20 patients over 3-13 weeks 3.
Mechanism of Benefit
- Petrolatum addresses the impaired skin barrier function in psoriasis by reducing transepidermal water loss (TEWL), which is significantly elevated in both lesional and peri-lesional psoriatic skin 4.
- Psoriatic skin shows decreased expression of aquaporin-3 (a water/glycerol transporter), leading to reduced skin hydration that petrolatum-based products can help mitigate 4.
Clinical Application Algorithm
For mild psoriasis:
- Use petrolatum-based products as the vehicle for coal tar (starting at 0.5-1% crude coal tar, increasing to 10% as tolerated) 1.
- Apply petrolatum liberally to maintain skin hydration between active treatments 1.
For moderate-to-severe psoriasis:
- Petrolatum serves as the base for dithranol preparations (0.1-0.25% initially, doubling concentrations as tolerated) 1.
- Consider petrolatum application before UV phototherapy sessions 2, 3.
As monotherapy:
- Petrolatum alone provides only symptomatic relief and does not modify disease activity 5.
- One controlled study showed Aquaphor alone (control arm) produced only 45% improvement in severity scores compared to 85% with active vitamin D analog treatment 6.
Critical Limitations
- Petrolatum has no anti-inflammatory or disease-modifying properties and should never replace proven topical agents like coal tar, dithranol, or topical corticosteroids for active disease management 1.
- The vast majority of psoriasis patients require topical agents of proven efficacy (tar, dithranol, or corticosteroids under supervision) rather than emollients alone 1.
- A study comparing topical fludarabine in Aquaphor versus Aquaphor alone found no significant difference, confirming that the vehicle itself provides minimal therapeutic benefit beyond moisturization 5.
Practical Recommendations
- Use Aquaphor as an adjunctive moisturizer to reduce scaling and improve skin comfort, but always combine with active topical therapy 1.
- Apply generously and frequently, particularly after bathing, to maximize barrier repair 4.
- For patients intolerant of more refined tar products, crude coal tar in petrolatum (though messier) is generally more effective than refined preparations 1.
- Avoid relying on petrolatum-based products as sole therapy, as this represents inadequate disease management and may delay appropriate treatment escalation 1.