Psoriasis is a chronic skin condition that causes red, scaly patches on the skin. This covers common questions about its causes, symptoms, treatment options, and ways to manage flare-ups effectively.
What is Psoriasis?
What is psoriasis?
Psoriasis is a long-lasting inflammatory skin condition in which your own immune system speeds up skin-cell turnover. New skin cells pile up on the surface before older ones have shed, creating well-defined red or salmon-coloured plaques covered by silvery-white scale. Lesions most often appear on the scalp, elbows, knees and lower back, but they can show up anywhere, including nails and joints. Because the inflammation is systemic, psoriasis is now recognised as a whole-body disease linked to arthritis and higher cardiovascular risk, not just a “rash.”
What causes it?
No single trigger causes psoriasis. You inherit a genetic tendency—having a first-degree relative raises your risk—but you still need environmental sparks. Common sparks include streptococcal throat infection (which can set off guttate flares), skin injury, certain medicines (lithium, beta-blockers, antimalarials), heavy alcohol use, obesity and smoking. These factors activate immune cells that release inflammatory messengers (cytokines), driving rapid skin-cell growth and visible plaques. The combination of genes plus triggers explains why some people develop psoriasis while others never do even with the same exposures.
Can stress trigger psoriasis?
Absolutely. Emotional stress is one of the most reported flare factors. Stress hormones like cortisol can dysregulate immune pathways, tipping the balance toward inflammation and new plaques. Many people notice outbreaks during exams, work deadlines or family crises, and studies show stress-management techniques (mindfulness, yoga, counselling) improve both symptoms and quality of life. Building stress-coping skills is therefore part of comprehensive care, alongside creams and light therapy.
Is it contagious?
No. Psoriasis is not an infection and you cannot “catch” it from someone’s skin or give it to family, friends or sexual partners. The redness and scale come from your own immune activity, not bacteria, viruses or fungi. Explaining this to others can reduce stigma and misunderstanding.
Who gets psoriasis?
Psoriasis can affect anyone-men and women equally-across all skin tones. It shows a “bimodal” age pattern, with peaks in late teens–20s and again in the 50s–60s, but children and older adults can also develop it. Lifestyle factors such as smoking or obesity raise risk, yet many healthy people also develop the disease because genetics play a large role.
How common is psoriasis in Canada?
Roughly 1.7 % of Canadians-about one in 60 people-live with psoriasis, which parallels the 2-3 % prevalence seen worldwide. That means over 600,000 Canadians are managing some form of the condition at any time.
What are the different types of psoriasis?
Plaque (vulgaris): the classic scaly plaques, accounting for 80–90 % of cases.
Guttate: sudden “dew-drop” spots after strep throat.
Inverse (flexural): shiny red patches in skin folds.
Pustular: painful pustules on palms/soles
Nail psoriasis: pitting, thickening or splintering
Each type has distinct features but shares the same underlying immune process.
Symptoms
What does psoriasis look like?
Picture small islands of dry, raised skin that feel thicker than the skin around them. They’re usually pink-red on lighter skin or purple-brown on darker skin and topped with a layer of silvery-white flakes. If you gently scratch the flakes, more seem to appear. Psoriasis tends to show up in the same spots on both sides of the body, most often on the elbows, knees, scalp, and lower back.
Where does psoriasis usually show up?
Common spots are the scalp, elbows, knees, tummy, lower back, and around the ears. Some people also get it on their nails, palms, soles, or in skin folds like the armpits and groin. The exact pattern is different for everyone, and it can even change over time.
Can psoriasis affect the scalp or genitals?
Yes. Scalp psoriasis can look like stubborn dandruff that creeps past your hairline. Genital or “inverse” psoriasis hides in warm, moist folds and shows up as smooth red patches without much flaking. Both areas can be treated safely, but they often need gentler creams.
What’s the difference between mild, moderate, and severe psoriasis?
Doctors look at two things: how much skin is covered and how much the condition bothers you. If only a few small patches are present and they don’t affect your life, it’s mild. When larger areas are involved—or crucial spots like hands, feet, face, or genitals - it’s moderate. Severe psoriasis means very wide coverage or symptoms that seriously limit sleep, work, or social life.
Can psoriasis cause pain or cracks in the skin?
Yes. On thick-skinned areas like palms, soles, or over joints, plaques can split open and bleed, causing sharp pain. Treating the inflammation and keeping the skin well-greased with ointments or thick creams usually closes these cracks within a couple of weeks.
Why does my skin stay dark or light after plaques fade?
When a plaque heals, it can leave a flat patch that’s darker (post-inflammatory hyperpigmentation) or lighter (hypopigmentation) than your normal skin tone. These colour changes are harmless and usually fade over six to twelve months. Gentle sun exposure and daily moisturizer help; avoid strong steroid creams on these spots so they can even out naturally.
Does psoriasis cause fatigue?
It can. Ongoing inflammation releases chemicals that make some people feel unusually tired. Poor sleep from nighttime itching adds to the problem. When the skin improves-especially if joint pain is also treated-energy levels often bounce back.
Steroid Potency Table
Can you share what are the least and most potent steroids?
Very thick, scaly plaques on elbows, knees, palms/soles, or stubborn scalp patches. Use once or twice daily for ≤ 14 days, then step down or switch to a non-steroid.
High
Betamethasone dipropionate 0.05 % ointment/cream
Diprosone® ointment
Tough plaques on arms, legs, or trunk that didn’t clear with mid-strength creams. Limit to 2–4 weeks of daily use before tapering.
Medium-High
Betamethasone valerate 0.1 % ointment
Betaderm® 0.1 % ointment
Step-up option for active flares on body or under occlusion (plastic wrap overnight) for nail or scalp spots. Good bridge between high-strength bursts and maintenance therapy.
Medium
Mometasone furoate 0.1 % cream / lotion
Elocom®
Reliable everyday strength for most body plaques. Lotion/solution versions spread easily through hair for scalp psoriasis.
Medium
Betamethasone valerate 0.1 % cream / lotion
Betaderm® 0.1 %
Versatile “work-horse” for flares on arms, legs, chest, or back when hydrocortisone is too mild. Often used once daily for 2–6 weeks, then weekends only.
Low
Desonide 0.05 % cream / ointment
DesOwen®, generic
Gentle choice for facial, neck, or fold (inverse) psoriasis. Rotate with tacrolimus/pimecrolimus for long-term control of sensitive areas.
Least Potent
Hydrocortisone 1 % cream / ointment
Emo-Cort®, Cortate®
Safest starter for face, neck, or groin flares; very low risk of skin-thinning when used as directed.
Can you share what are non-steroid treatment options?
Group
Medicine & Strength
Brand
Available Formats
How & Where to Use
Vitamin D
Calcipotriol 50 µg/g
Dovonex®
Cream, Ointment
Mild plaques on body or scalp. Spread a thin layer morning and evening for 8–12 weeks; once flat, cut back to weekdays only.
Calcitriol 3 µg/g
Silkis®
Ointment
Gentler choice for face, folds, or groin. Apply twice a day; less sting than calcipotriol.
Ideal for scalp or hairy skin. Shake, spray, rub in every night for 4 weeks; afterward, twice a week keeps skin clear.
Calcineurin inhibitors
Tacrolimus 0.1 %
Protopic® 0.1 %
Ointment
First-line steroid spare for adults on face, eyelids, groin, under breasts. Pea-sized amount morning and evening until clear (up to 8 weeks), then twice weekly to prevent relapse.
Tacrolimus 0.03 %
Protopic® 0.03 %
Ointment
Same schedule for children ≥2 y or adults who find 0.1 % too strong.
Pimecrolimus 1 %
Elidel®
Cream
Alternative when tacrolimus stings. Apply morning and evening; shift to twice weekly once plaques settle.
TeleTest Psoriasis Flare Tables
The following table identifies options to treat psoriasis flares for each specific body part. You will be able to select your desired option at the time of your consultation with a TeleTest physician.
Flare - Face / Groin / Genitals / Under-breast Folds
Drop onto nail at base (i.e. where the nail starts) nightly, occlude
Up to 4 wks, then rest
Because high-quality studies on combination treatments for nail psoriasis are limited, dermatologists often rely on their own clinical experience. This means management plans can differ from one specialist to the next. If you’ve used a therapy that worked well for you before, mention it during your consultation so your dermatologist can factor it into the treatment plan.
Long-Term (Maintenance) Schedule
How to read these tables
Each body-area table gives separate options, not steps that must all be layered together.
Start with Option A. If that alone no longer keeps the skin clear, switch to-or add-the next option listed.
Maintenance - Face / Groin / Genitals / Under-breast folds
Option
Medicine (brand / vehicle)
When to apply
Weekly rhythm
A (primary)
Tacrolimus 0.1 % (Protopic® oint)
Evening
Mon & Thu
B (alternative)
Calcitriol 3 µg/g (Silkis® oint)
[avoid use on the face]
Bedtime
Mon → Fri
C (rescue)
Hydrocortisone 1 % (Emo-Cort® oint)
Morning
Sat & Sun only
D
ZORYVE® cream 0.3 %
Evening
Mon, Wed, Fri
Maintenance - Eyelids / Skin around Eyes
Option
Medicine
When
Weekly rhythm
A
Tacrolimus 0.1 % (Protopic®)
Very thin dab in the Evening
Tue & Fri
Maintenance - Ears (outer canal ± ear lobe)
Option
Medicine
When
Weekly rhythm
A
Fluocinolone 0.01 % (Dermotic® drops)
2 drops in canal
Sunday
[requires ear exam ~ 3 months]
B
Tacrolimus 0.1 % (Protopic® oint)
Coat outer ear skin
Wed & Sat
Use of Dermotic® ear drops as maintenence therapy is 'off-label' as it hasn't been studied, and follows the same principles as weekend steroid maintenance applied to other body parts. Therefore, a quarterly ear exam is warranted through a local clinic while using Dermotic® to evaluate for any effects on the ear drum where exposure is likely to occur.
Maintenance - Neck & Skin-folds
Option
Medicine
When
Weekly rhythm
A
Calcitriol (Silkis®)
Bedtime
Mon → Fri
B
Tacrolimus (Protopic®)
Evening
Tue & Fri
C
Betamethasone valerate 0.05 % (Betaderm® cream)
Morning
Sat & Sun only
D
ZORYVE® cream 0.3 %
Evening
Sat & Sun
Maintenance - Trunk • Arms • Legs
Option
Medicine
When
Weekly rhythm
A (primary)
Calcipotriol 50 µg/g (Dovonex® cream/oint/gel)
Thin layer PM
Mon → Fri
B (weekend boost)
Calcipotriol + Betamethasone (Dovobet® gel / Enstilar® foam)
Brush on cuticle and surrounding skin once nightly
Mon, Wed, Fri
B
Tacrolimus 0.1 % (Protopic®)
Brush on cuticle twice daily and surrounding skin
Tue & Fri
C
Calcipotriol (Dovonex® oint)
Brush on cuticle and surrounding skin once nightly (Do not occlude)
Tue, Thu, Sat
Remember
FTU rule: One fingertip unit ≈ 0.5 g treats two adult palm areas. Staying under ~200 FTU/week keeps you well below systemic-absorption risks.
Escalate smartly: If Option A alone no longer holds the gains, switch to or add the next option—don’t jump straight back to daily high-potency steroids.
Photo check-ins: Monthly phone photos help spot small relapses early so you can fine-tune the schedule with your TeleTest physician.
Custom Compounded Prescriptions
We work with a custom compounding pharmacy. Please email support@teletest.dev before ordering a psoriasis panel so we can confirm the specific mix is available.
Which custom-compounded prescriptions can TeleTest arrange for psoriasis flares?
We only list mixes that must be prepared by a compounding pharmacy (commercial brands like Dovobet® are not included). Because supply chains change, especially for raw tazarotene, please email support@teletest.ca before ordering so we can confirm the pharmacy can make the formula and quote current pricing.
Mometasone 0.1% + Salicylic acid 5% ointment
– Thick plaques on elbows, knees, or scalp
– Apply twice daily for 2–4 weeks, then step down to plain mometasone two days per week for upkeep.
Tacrolimus 0.1 % ointment + Salicylic acid 6% in ammonium-lactate base
– Hyper-keratotic plaques on palms or soles
– Spread a thin layer nightly and cover with cotton gloves/socks for 4–6 weeks; continue tacrolimus three nights weekly once clear.
Hydrocortisone 1 % + Calcipotriol 0.005 % cream (1 : 1 mix)
– Sensitive areas (face, groin, skin folds)
– Apply once nightly for up to 2 weeks during a flare, then switch to tacrolimus 0.1% ointment twice weekly for maintenance.
Compounded Tazarotene 0.1 % gel (current supply shortage makes this a custom item)
– Stubborn body plaques or nail psoriasis
– Body use: apply every night to plaque edges; Nail use: dab onto cuticle and under nail tip nightly, then occlude with a small bandage for 4–6 months.
Protopic and Elidel
What are these creams and when are they used for psoriasis?
Tacrolimus 0.1% ointment (Protopic®)
Pimecrolimus 1% cream (Elidel®)
Both are prescription “immune-calming” creams approved in Canada for eczema. Dermatologists also use them off-label as steroid-sparing options for delicate skin such as the face, eyelids, groin, armpits, and under breasts. Clinical trials show they can clear thin-skin plaques within eight week
Why TeleTest physicians prefer Protopic® 0.1%:
Tacrolimus 0.1% delivers stronger anti-inflammatory action than Elidel®, so it is our first choice if stinging is acceptable and the area is not overly sensitive. Elidel® 1% is a good alternative when tacrolimus causes persistent burning.
How do I use them?
Wash and pat the area dry.
Apply a pea-sized amount twice daily for up to eight weeks.
Expect mild stinging or burning for the first few days—this usually fades. Putting the cream on completely dry skin reduces that sting.
Once clear, drop to twice-weekly “maintenance” applications to keep plaques away.
What benefits did studies show?
Pimecrolimus 1%: 71% of patients with fold psoriasis were clear or almost clear at 8 weeks vs 21% on placebo.
Tacrolimus 0.1%: 65% of patients with facial or fold psoriasis were clear or almost clear at 8 weeks vs 31% on placebo
What side effects should I watch for?
Mild burning or itch can occur in the first week and improves with ongoing use. Rarely, redness may flare for a few hours after drinking alcohol (facial flushing). Avoid using on infected or broken skin. Because only tiny amounts enter the bloodstream, overall safety is good, but if irritation lasts beyond two weeks, contact your TeleTest physician.
I heard about a cancer warning—what’s the current advice?
The 2005 cancer warning came from concerns seen with high-dose oral versions of these drugs given to organ-transplant patients, where the immune system is deliberately weakened for years. The tiny amounts in topical tacrolimus (Protopic®) or pimecrolimus (Elidel®) are hundreds of times lower and stay mainly in the skin. Large, long-term studies—including many conducted in children who use these creams for eczema—have not shown an increase in skin cancer or lymphoma when the medicines are used as directed on small areas. Based on this evidence, regulators have removed the boxed warning, and Canadian dermatology guidelines consider these creams safe for limited-area, steroid-sparing use in both adults and children.
Coal Tar - Yes, Actual Coal Tar
What is coal tar and why is it used for psoriasis?
Coal tar is a thick, dark liquid made from coal. When placed on psoriasis plaques it slows the skin cells that build up too quickly and eases redness and itch. Modern studies show that low-strength tar lotions and shampoos can improve mild-to-moderate psoriasis within 4–12 weeks. Because it does not thin the skin, tar is often used between steroid courses or for people who prefer a non-steroid option.
How do I apply it safely?
Scalp: Massage a 3 %–6 % tar shampoo into a dry scalp, leave on five minutes, then rinse. Use three times a week.
Body plaques: Smooth a 1 %–2 % lotion or 15 % LCD (liquor carbonis detergens) solution on plaques once daily, preferably at night. Wear dark sleepwear to avoid stains.
Skip tar if you are pregnant or breastfeeding (safety data are limited).
Tip: start with every-other-day use to test skin tolerance, then work up to the recommended schedule.
Can I combine coal tar with my other treatments?
Yes. Tar loosens scale so prescription creams (for example, corticosteroids or vitamin D creams) can sink in better.
What are over-the-counter coal-tar products that I can buy?
You can buy these products at Shoppers Drug Mart, Wal-Mart or Rexall.
Thin layer on body plaques nightly; wash off in morning if sticky
MG217 Medicated Coal Tar Shampoo
3 %
Lather, leave 5 min, rinse; 3 × weekly
Coal Tar Lotion 1 %
1 %
Apply once daily to plaques for up to 12 weeks
Steroid Creams
Why do doctors often start with a steroid cream for psoriasis?
Steroid creams calm the immune buzz in your skin, slow the runaway growth of new cells, and shrink the leaking blood vessels that make plaques red. Because they act fast, they’re the go-to for a sudden flare on a small area. In research trials, moderate-to-high strength creams cleared or greatly improved plaques in two to four weeks for roughly seven out of ten adults. Think of steroids as the “fire extinguisher” that knocks back flames quickly so longer-term, gentler products (vitamin D, tacrolimus) can keep things cool.
How strong is “strong”?
Pharmacists rank steroid creams from Class 1 (ultra-high) down to Class 7 (mild). Most adults start in the middle-Classes 2-5-because they hit a sweet spot between power and safety. Ultra-high options like clobetasol 0.05% or halobetasol 0.05% are saved for thick plaques on elbows, knees, palms, soles, or the scalp. Delicate places-face, groin, armpits-need only low-strength hydrocortisone 1% or a non-steroid alternative. Your doctor also matches the “vehicle” (cream, ointment, foam) to the body site: foams glide through hair, ointments stick to dry plaques, and lotions spread easily over large areas.
How long can I stay on a potent steroid without harming my skin?
Dermatology guidelines say twice-daily use of high- or ultra-high potency steroids for up to four weeks is generally safe with minimal risk of thinning. Stick to the fingertip-unit rule: one fingertip of cream (0.5 g) covers two palm-sized areas.
After the initial burst, shift to weekend-only use or swap to a vitamin D or tacrolimus cream during the week-this keeps plaques quiet without over-using steroid.
What side-effects should I watch for, and how common are they?
Local problems appear first: skin thinning, easy bruising, tiny red blood vessels, stretch-mark streaks, or acne-like bumps. These show up mainly on thin skin (face, groin, forearms) after months of daily use. Systemic effects-mood shifts, weight gain, high blood sugar-are rare and usually linked to covering huge areas or applying under occlusion for many weeks. Large reviews found no meaningful drop in morning cortisol for most people after four weeks, even with strong steroids; where cortisol dipped, it bounced back once treatment paused. Bottom line: short bursts on limited skin are very safe; problems come from continuous, high-dose use.
How do I come off a steroid cream without rebounding?
Never stop a potent cream cold-turkey after long daily use. A simple taper is:
Week 1: once daily instead of twice.
Week 2: every other day.
Week 3: Saturday–Sunday only.
At the same time, start a non-steroid (vitamin D, calcineurin inhibitor) twice daily on weekdays. This hand-off keeps inflammation low while your skin regains its natural barrier.
Are steroid creams safe in pregnancy or breastfeeding?
Yes - when used wisely. Expert consensus says less than 60 g per week of a low- or mid-strength steroid is safe during pregnancy. Potent steroids on large areas for many months may slightly lower birth weight, so keep doses small and areas limited. Breastfeeding mothers should avoid putting potent creams on nipples but can treat other spots; wash hands before holding the baby.
What if one stubborn plaque or thick nail won’t budge?
Doctors can inject a tiny amount of triamcinolone (a steroid) directly into a resistant plaque, scalp spot, or nail matrix. Doses are small—up to 20 mg/mL—every three to four weeks. Many patients see flattening within two shots. Because injections can sting and may cause local dents if overdone, this approach is reserved for single, hard-to-treat lesions rather than widespread rashes.
Vitamin D Creams
Do vitamin D creams work as well as the really strong steroid creams for psoriasis?
Surprisingly, yes. In one study that followed more than 250 people with plaque-type psoriasis for six weeks, a vitamin D ointment called calcitriol cleared skin just as well as a powerful steroid cream. Even better, when doctors checked again weeks after everyone stopped treatment, about half of the people who had used calcitriol stayed clear, while only a quarter of the steroid group did.
What this means for you:
Similar results, fewer worries. Vitamin D creams calm the over-active skin cells without the long-term risks of steroid thinning or stretch marks.
Great for the “long game.” Many people use a strong steroid for a brief flare, then switch to calcitriol or calcipotriol several days a week to keep plaques from sneaking back.
Gentler on delicate spots. Because it doesn’t thin skin, vitamin D ointment is handy for the face, folds, or thin-skinned areas.
Patience counts. Flakes often soften in the first two weeks, but the smoothest results show up after about six to eight weeks of steady use. If it tingles, apply moisturizer first or use it every other day until skin settles.
Always follow the schedule your prescriber gives and let them know if you feel irritation or start any new supplements.
Are vitamin D creams (like calcipotriol) safe for long-term use, and what skin reactions should I expect?
Yes. Clinical studies following patients for a full year show that vitamin D creams are generally safe and keep working without “losing effect” over time. Up to one-third of users notice mild, temporary skin reactions where they apply the cream. The most common are burning, itching, slight swelling, peeling, dryness, or redness. These changes can happen on the plaques themselves or on the normal skin right beside them. The good news is that these irritations usually fade after a week or two as your skin adjusts. Using the medicine exactly as prescribed (for example, thin layer twice a day on weekdays, rest on weekends) and applying a moisturizer 30 minutes later often prevents most discomfort. If stinging or redness lasts more than two weeks, let your clinician know-sometimes switching to the gentler calcitriol formula or using the cream once a day instead of twice is all that’s needed.
Can vitamin D creams raise my calcium levels or affect my hormones?
Vitamin D psoriasis creams work mostly on the skin surface, so they almost never change the calcium in your blood. In long-term studies only a few people-about 3 in 100-showed a tiny, harmless bump in calcium, and none had to stop treatment. The small risk appears only when very large areas (roughly one-third of the whole body) are covered every day or when people use more than 100/g of cream in a single week.
A simple way to stay well below that limit is to count fingertip units: one strip of cream from the tip of your index finger to the first crease equals 0.5g. Staying under 200 fingertip units per week keeps you in the safe zone. If you have kidney problems or a known calcium disorder, let your doctor know; they might check a blood test after a few months just to be sure. For everyone else using the cream on limited plaques, routine blood tests aren’t needed, and hormone shifts are vanishingly rare.
Which vitamin D skin medicines can I get in Canada?
Three formulations are routinely stocked:
Calcipotriol 50 µg/g (brand Dovonex® cream or ointment) - prescription, single agent.
Calcitriol 3 µg/g (brand Silkis® ointment) - prescription, often chosen for very sensitive areas.
How do these creams help my plaques?
They attach to vitamin D receptors in the skin, slowing the growth of new cells and helping existing cells mature normally. That flattens plaques and reduces scale without thinning the skin. Most studies show visible improvement after 4 weeks and clearer skin by 8–12 weeks with twice-daily use.
Do I keep using them once my plaques look better?
Yes. A common plan is “weekday vitamin D, weekend steroid.” Apply calcipotriol or calcitriol twice daily Monday–Friday, then a strong steroid once or twice daily on Saturday and Sunday.
Can I use them on my scalp?
Calcipotriol comes as a foam (Enstilar®) and a gel; both spread easily through hair. Part the hair, spray or squeeze a thin line on the scalp, and rub in gently. Leave on overnight or at least 4 hours before washing.
What side effects should I watch for?
Mild redness, burning, or dryness happens in up to one-third of users and usually fades within 2 weeks.
Are vitamin D creams safe during pregnancy or while breastfeeding?
They can be, when used carefully. Only a tiny amount of the medicine soaks through the skin into the bloodstream, and studies have not linked it to birth defects or problems in nursing babies. Canadian and international guidelines say it’s reasonable to use a vitamin D cream on small areas if the benefits-less itch, healthier sleep, fewer cracks-outweigh any potential risk. Most clinicians start with plain moisturizers or a mild steroid first, then add the vitamin D cream if stronger help is needed.
Tips for extra safety: apply a thin layer once or twice a day on the plaques only, keep the treated skin covered when holding or nursing your baby, and avoid putting the cream on or near the nipple. Always tell your obstetrician, family doctor, or midwife about any prescription.
Tazarotene (Arazlo)
What exactly is tazarotene?
Tazarotene (Brand: Arazlo) is a vitamin A-based medication (cream/lotion) that’s been used for psoriasis since the late 1990s. It slows down the skin cells that pile up in a plaque and helps calm inflammation. Doctors usually reach for it when a few stubborn patches refuse to flatten after steroid cream, or when thick scale keeps coming back. It’s handy for plaques on the arms, legs, or trunk, and can even thin hard skin on palms or soles.
How do I start tazarotene without my skin burning or peeling?
Go “low and slow.” Use a pea-sized amount just on the plaque every other night for the first week. If the skin feels okay, switch to nightly. Follow 30 minutes later with a thick moisturizer, or put moisturizer on first and tazarotene after a short wait-both tricks cut sting and dryness.
When should I expect to see a change?
Most people notice plaques looking a bit flatter and less flaky by week 4, with clearer skin by weeks 8-12 if they stay consistent. It’s normal for the area to look slightly red or drier at first-think of it as the cream doing its job rather than a setback.
Can I mix tazarotene with my steroid cream?
Yes, and it often works better that way. A popular routine is steroid in the morning to calm redness fast, tazarotene at night to keep plaques thin and prevent rebound. Studies show this combo smooths skin longer than using either one alone.
Can I use tazarotene if I am pregnant or trying to get pregnant?
No. Tazarotene is not safe in pregnancy because vitamin A medicines have been linked to birth defects. If you could become pregnant, you should take a pregnancy test within two weeks before starting the lotion and use reliable birth control while on it. Stop the medicine right away if you're pregnant.
Is tazarotene allowed while I am breastfeeding?
Because no human studies show how much of the drug passes into breast milk, most experts advise choosing a different treatment while nursing. Safer options include low-strength steroid creams or vitamin D creams on small areas.
Nail Psoriasis
What kinds of nail psoriasis are there?
There are two common forms:
Nail-matrix psoriasis (affects the nail “factory”)
Nail-bed psoriasis (affects the skin underneath an already-formed nail)
How do they differ (matrix and bed) nail psoriasis?
Nail-matrix psoriasisWhere it is: Deep under the skin at the base of your nail, in the spot where new nail cells are produced.
What you see: Because the problem starts where the nail is made, each new millimetre of nail can come out with tiny pits, grooves, or a crumbly texture. These changes grow forward with the nail.
Nail-bed psoriasisWhere it is: In the thin layer of skin that sits directly under the hard nail you can tap on.
What you see: Colour changes (yellow-orange spots), the nail lifting off the finger, or chalky debris collecting under the tip. The existing nail is affected, rather than the new nail that is still growing.
Why does knowing the difference matter for treatment?
Nail-bed disease often improves with strong prescription creams, ointments, or lacquers because the medicine can seep down to the affected skin.
Nail-matrix disease is harder to reach through the thick nail plate; it may need injections around the base of the nail or medicines that treat psoriasis from the inside (tablets or biologics).
Growth speed is different too: nail-matrix changes take a full nail-growth cycle to clear (months), while nail-bed changes can look better once inflammation settles and debris is removed.
Which type usually responds to creams, lacquers, and ointments?
Bed psoriasis: often improves with strong steroid or vitamin-D–based products applied over the nail and under the free edge.
Matrix psoriasis: topicals alone rarely work well because they can’t “soak through” the nail to reach the growth zone.
Do application steps change for nail-bed vs nail-matrix psoriasis?
A. If your main issue is nail-bed psoriasis
(oil-drop spots, nail lifting, chalky build-up under the tip)
Thin coat on the nail surface
Brush or rub the medicine over the whole nail.
Work it under the free edge
Gently lift (or press back) the skin at the tip and massage a small amount underneath—this is the shortest route to the nail bed.
Seal if advised
Some lacquers or ointments work better if you cover the nail with a fingertip cot overnight.
B. If your main issue is nail-matrix psoriasis
(pits, ridges, crumbling that starts near the cuticle)
Target the base of the nail
Apply a thin layer over the skin where the nail meets the finger (the cuticle area). You can gently push back the cuticle after a warm soak, then massage the medicine into that crease. Be careful not to near the skin or be too aggressive.
Cover the visible nail too
Spread the medication over the entire plate; it may still help as the nail grows out.
Consider occlusion
If recommended, place a fingertip cot overnight to keep the drug in contact with the base.
Stay consistent
Because new nail must grow from the base outward, daily use for many months is usually needed.
How long before I see a change?
Area involved
First visible improvement
Full recovery time*
Nail bed (tip)
4-8 weeks
3-6 months
Nail matrix (base)
2-3 months
6-12 months fingers
12-18 months toes
Quick Tips for Everyday Care
Keep nails short to reduce leverage that lifts them.
Wear cotton gloves under waterproof gloves for wet work.
Avoid picking debris-soak and gently file instead.
Report any sudden swelling, redness, or pain (possible infection) to your doctor.
What’s the most-effective treatment if creams don’t work?
For stubborn nail-bed psoriasis (colour change, lifting, debris):
Potent topical lacquers/ointments + occlusion are still first-line, but if several nails remain affected a systemic tablet or injection that treats psoriasis throughout the body (e.g., methotrexate, or biologic agents) gives the highest clearance rates in clinical studies.
For stubborn nail-matrix psoriasis (pits, ridges, crumbling):
Tiny steroid (or less commonly methotrexate injections) through the skin at the base of each nail are the most effective local option. When multiple nails are involved - or if there is joint pain - the same systemic drugs/biologics listed above work best.
Can light-based treatments (phototherapy or radiation) fix nail psoriasis?
Short answer: usually not - and they’re almost never a first-line choice.
Why standard UV light therapy (narrow-band UVB or UVA) falls short
The hard nail plate blocks most rays, so very little reaches the inflamed skin beneath.
Studies show little to no change in nail thickness or colour after weeks of sessions.
You would need several clinic visits each week for months to see even modest benefits.
Is oral (pill) methotrexate an option if my nail psoriasis isn’t clearing with creams or injections?
Yes. Methotrexate is an immune-modulating tablet that can help when several nails - or the skin and joints-are involved. Dermatologists often choose it when:
Multiple nails or both hands/feet are affected and daily tasks are difficult.
There is psoriatic arthritis or widespread skin plaques at the same time.
You prefer a once-weekly tablet over injections or biologic medicines.
Who prescribes methotrexate?
Only physicians experienced in systemic psoriasis care-dermatologists (or sometimes rheumatologists) - start and supervise methotrexate. You’ll need a referral from your family doctor or a walk-in clinic for the specialist consult, as these medications require lab monitoring and carry specific risks like an increased risk of bone marrow suppression and cancer.
Tazarotene on Nails
What’s the best way to put tazarotene on my nails?
Trim and clean the target nail at night.
Squeeze out a grain-of-rice drop of 0.1 % gel (or 0.045% Arazlo lotion)
Massage it into the cuticle, under the nail tip, and the skin on both sides.
Cover the nail with a small piece of plastic wrap or a fingertip bandage.
Wash hands in the morning
In a 6-month study, this exact evening routine shrank lifted nail edges and reduced pits better than plain gel. Occluding the nail helps the medicine soak through the hard plate and speeds results.
Do I have to cover every treated nail?
Covering is optional but useful. In the same trial, nails wrapped with thin plastic film healed faster, yet uncovered nails still improved. If wrapping feels fiddly, try cotton gloves or socks overnight; they give a mild “occlusion” without tape. Choose whichever method you’ll actually keep up for months, because consistency matters more than perfect technique.
How long before I know if it’s working?
Nails grow slowly, so give the gel at least 4 months before judging. In the study, clearer, stronger nails showed up between months 4 and 6. Take monthly photos to spot small wins—less lifting, fewer pits, smoother edges. If there’s no change after 6 months of faithful use, ask your doctor about other options like steroid injections or an oral medicine.
What side effects should I watch for around the nails?
Only 5 of 31 people in the trial reported problems, all mild: peeling skin near the cuticle, redness, tenderness, or a small paronychia (hang-nail infection).
Tips to cut irritation: use a tiny amount, keep the gel on the nail not the fingertip skin, and moisturize the surrounding skin in the morning.
How does Tazarotene compare to Clobetasol?
Sign measured
Average improvement after 12 weeks
What happened 12 weeks after stopping treatment
Pitting
Both creams cut the score by ~70 %
Slid back toward baseline in both groups
Onycholysis (nail lifting)
~60 % drop with either cream
Partial relapse in both groups
Hyper-keratosis (chalky debris)
Big drop with both, but tazarotene held more of the gain
Clobetasol group lost most of the benefit
Salmon-patch colour
Similar drop in both groups
Modest relapse; tazarotene still slightly ahead
ZORYVE® (roflumilast 0.3%)
What exactly is Zoryve and who can use it?
Zoryve is a non-steroid anti-inflammatory cream or foam that blocks the enzyme PDE-4. Health Canada has approved 0.3 % cream for plaque psoriasis on the body including folds in people ≥12 years, and 0.3 % foam for scalp-and-body plaques in the same age group.
Where on my body can I put it-including the face?
Body plaques & skin-fold (intertriginous) psoriasis: use the cream.
Scalp or very hairy areas: the foam spreads more easily.
Face & neck: not specifically studied, but dermatologists do use the cream on small facial patches because it is steroid-free and non-thinning-avoid the eyelids and keep out of eyes. If in doubt, test a 2 cm spot for three days first.
How often and how long can I keep using it-can I go a whole year?
Yes. The product monograph allows once-daily, continuous use. One-year extension studies found no new safety issues-most people stayed clear with the same daily schedule. Mild redness or burning at first use cleared in a few days, and no blood tests were needed.
How quickly will it calm my plaques?
Many users notice less itch within 48 hours. Visible flattening of plaques and reduced scale usually appear by week 2-4, with peak clearing around week 8 in clinical trials. If nothing has changed by week 8, tell your TeleTest physician - an alternative plan may work better.
Do I need to combine it with steroids or vitamin D creams?
Zoryve can be used alone. If you and your clinician prefer, you can rotate: Zoryve during the week plus a weekend steroid (or vitamin D combo like Dovobet®) for stubborn areas. Always leave at least 4 hours between products to avoid dilution.
What side-effects should I watch for?
Most people feel nothing or just mild warmth. About 3–5 % report temporary burning, redness, or itching at the start. Headache and diarrhea were rare (<1 %). Stop and call a doctor if burning lasts more than a week or if you see a rash outside the treated area. No skin thinning, stretch marks, or calcium problems were seen in long-term studies.
Salicyclic Acid
What does salicylic acid do for my psoriasis plaques or scalp flakes?
Salicylic acid is a “scale-looser.” It breaks the sticky links between dead skin cells, so thick psoriasis scale lifts off more easily. When the scale thins, other medicines—like steroid or vitamin D creams-can soak in and work better. Creams and ointments (2%-6%) are used for body plaques; shampoos (3%-6%) target the scalp. . In one study, a 6 % salicylic‐acid lotion used nightly for four weeks cut the average scalp-psoriasis score by more than half. Expect softer, flatter plaques in two to four weeks, with best results after eight to sixteen weeks of steady use. Think of it as a gentle “chemical file” that smooths the surface so your main treatment can do the heavy lifting.
How do I combine salicylic acid with my other creams without reducing their effect?
Timing is everything. Use salicylic acid first—often at bedtime—to loosen scale overnight. In the morning, gently wash or brush off the softened flakes, pat the skin dry, and then apply your prescription steroid, vitamin D cream, or tacrolimus.
Aloe Vera
Can rubbing aloe vera on my plaques actually help?
Maybe, but don’t expect miracles. In one small study of 60 adults with mild plaque psoriasis, putting pure aloe gel on three times a day for four weeks cleared the skin in 83 % of users, while only 7 % on plain placebo gel cleared. Yet another study of 40 people—using aloe twice daily—found no difference from placebo at four weeks. Dermatologists believe aloe’s soothing effect is similar to a good moisturizer: it cools redness and softens scale, but it doesn’t shut down the immune signal that drives psoriasis. Bottom line: aloe can be part of your routine for comfort, but keep using your prescription creams to control the disease.
How should I choose and use an aloe product?
Look for a gel labelled “99 % pure aloe” with few added fragrances or dyes. Brands sold at Canadian chains-such as the Life Brand 99 % Aloe Vera Gel (Shoppers Drug Mart) or Equate 97 % Aloe Gel (Walmart)-fit this bill. Apply a thin layer to the plaques two to three times daily for at least four weeks and let it dry before dressing. Storing the bottle in the fridge adds an extra cooling effect that many people enjoy during itchy flares.
Vitamin D Supplements
Will taking vitamin D pills clear my psoriasis, and should I still take them?
Current research says no-oral vitamin D at safe daily doses doesn’t shrink plaques or cut flare frequency. Trials that used moderate doses (up to 4 000 IU/day) found no direct skin benefit unless blood calcium crept high, which carries its own risks. So tablets aren’t a treatment for psoriasis itself.
That said, many Canadians run low on vitamin D over winter, and good levels support bone strength, mood, and immune balance in general. Most dermatologists therefore suggest 2 000 IU once daily as a “maintenance” dose for overall health, not for skin clearance.
Bottom line: keep using your prescription topical vitamin D cream for skin control, and take 2 000 IU/day orally for wider health benefits-just don’t expect the pill alone to calm your psoriasis.
This information is for education only and does not replace personalized medical advice. Always consult a qualified healthcare professional for diagnosis and treatment tailored to you.
