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What common ingredients in topical therapies for plaque psoriasis may cause irritation for your patients?

Psoriasis

You. As important to me as what's in a product is what is not in a product. An ingredient that is in many, many topicals used for psoriasis is propylene glycol, and propylene glycol is a well known irritant and allergen. In fact, the Journal of American Academy of Dermatology published a review in November 2019 of common allergens that are in topical corticosteroids, topical calcium inhibitors, and other topical immunomodulators. At least one allergen was found in 73.6% of the topical corticosteroids that they looked at. Among these allergens were things like methyl isothiozolinone, sorbitan derivatives, parabens, lanolin. But by far the most prevalent allergen found in these products was propylene glycol. 56.6% of the products reviewed in that study had propylene glycol in them, and roughly 4% of patch test patients are positive to propylene glycol, and that number is likely to be higher than 4% in patient populations with more cumulative exposure to topical corticosteroids that have used them chronically, like psoriasis and eczema patients, patients with sensitivity or allergy to propylene glycol or other common ingredients may find that psoriasis fails to improve or even worsens despite the application of a medication that typically improves such a condition. There's a fantastic list of generics in that review that do not contain propylene glycol. Again, I use empoise and sernivo because in my experience, they are by far the easiest propylene glycol free topical cord of steroids for patients to obtain. But any propylene glycol free product is less likely to cause irritation and allergy and therefore may be more likely to improve clinical outcomes.

What common ingredients in topical therapies for plaque psoriasis may cause irritation for your patients (how do these ingredients affect clinical outcomes?) 