OTC first-line treatments recommended by medical guidelines. Manage mild psoriasis with effective topical treatments like 1% hydrocortisone for reducing inflammation and keratinolytics, such as salicylic acid or coal tar, to address scaling. For recurrent or severe flares, prescription-strength corticosteroids or systemic agents may be necessary. Ask your doctor about biologic therapies for moderate-to-severe cases to achieve better control and improve quality of life.
January 8, 2025

Psoriasis: Best Over-the-Counter Management Steps

Evidence-Based Over-The-Counter Guide

William Shen

William Shen

Co-founder & CPO

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Psoriasis is a chronic immune-mediated disease that presents with inflamed plaques covered by silvery scales. Treatment depends on severity and impact on quality of life.

If less than 3–5% of total body surface area is involved, over-the-counter topical agents can play a role in management.

First-line recommendation for mild disease:

  • Topical corticosteroids: reduce inflammation and plaque formation in mild cases. Dose: 1% hydrocortisone may be used during disease flares until skin lesions improve, or as maintenance therapy for patients with frequent, recurrent flares at the same site. Hydrocortisone 1% psoriasis lotion (FDA M017).

  • Keratinolytics: Salicylic acid 2% cream (FDA M006) and coal tar products can be used to reduce scaling. Topical tazarotene may be more clinically effective but is available only by prescription.

Prescription medications:

  • Higher strength topical corticosteroids: medium-potency (e.g., triamcinolone 0.1%) or high-potency (e.g., fluocinonide 0.05%)

  • Systemic agents (e.g., methotrexate, cyclosporine): For widespread or resistant disease.

  • Biologic agents (e.g., TNF inhibitors, IL-17 inhibitors): For moderate-to-severe cases.

Citations:

Armstrong, A. W., & Read, C. (2020). Pathophysiology, clinical presentation, and treatment of psoriasis: a review. Jama, 323(19), 1945-1960.

What OTC evidence is reviewed?

  • For each condition, we performed a literature review to find a recent widely cited expert group guideline published in the leading specialty-specific peer-reviewed journal or top general medical journal.

  • Based on the recommendations in the publication, we identify recommended active ingredients and devices that are available over-the-counter per FDA regulations.

What evidence is prioritized?

Levels of evidence considered:

  • Tier 1 (Safe and Definitely Effective): Professional field consensus or multiple randomized controlled clinical trials showing the same conclusion. Wherever possible, we use Tier 1 evidence for "first-line" recommendations.

  • Tier 2 (Safe and Probably Effective): Individual clinical trials which may be discordant or large-scale observational experience. Tier 2 evidence may inform "first-line", "second-line", or "supplement" recommendations.

  • Tier 3 (Safe and Maybe Effective): Mechanistic plausibility without high-quality clinical evidence of efficacy but high-quality evidence of safety. Tier 3 evidence may inform "second-line" or "supplement" recommendations.

How does MDandMe select recommended products?

  • Based on the top clinical recommendation, we evaluate products containing the recommended active agent with FDA-approved dosage based on price, average customer reviews, how often it is purchased, and how quickly it will ship to home. 

  • We provide public documentation of the active ingredients in our recommendations, using all 32 FDA monographs, Prescription-to-Nonprescription (Rx-to-OTC) Switches, as well as New Drug Application (NDA) approvals.

How does MDandMe select recommended devices?

  • Based on the top clinical recommendation, we evaluate devices that are FDA-cleared or comply with other medical guidelines (if not a FDA-regulated category) by reputability, price, and average customer reviews.

  • We provide public documentation of supporting evidence for each device.  

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