What are the topical treatment options for psoriasis?

From the Guidelines

Topical treatment with calcipotriene and hydrocortisone is the most effective option for psoriasis, particularly for facial psoriasis, as it has been shown to be more effective than either agent alone in achieving clear or almost clear status. The use of combination treatments with vitamin D analogues and potent topical corticosteroids has been found to be more effective than either agent alone for the treatment of psoriasis 1. For example, a study found that calcipotriene 0.005% plus betamethasone 0.064% once or twice daily achieved clear or almost clear status in 69% to 74% of patients compared to 27% of patients treated with vehicle control 1.

When considering treatment options, it's essential to take into account the potential interactions between topical agents and other treatments, such as phototherapy. Vitamin D analogues can be used in conjunction with phototherapy, but should be applied after the phototherapy treatment to avoid inactivation by UVA and blocking UVB radiation 1.

Some key points to consider when using topical treatments for psoriasis include:

• Using the least potent agent that allows for disease control to minimize the risk of side effects
• Applying treatments to slightly damp skin after bathing for optimal results
• Using combination treatments with vitamin D analogues and potent topical corticosteroids for better efficacy
• Avoiding the use of multiple topical agents that may have compatibility issues, such as calcipotriene and topical lactic acid 1
• Regularly examining patients to monitor for side effects and adjust treatment as needed 1.

In terms of specific treatment regimens, calcipotriene foam has been shown to be more effective than vehicle in achieving an Investigator’s Static Global Assessment score of 0 (clear) or 1 (almost clear) for the treatment of scalp psoriasis 1. Additionally, the use of calcipotriene or tacalcitol ointment combined with hydrocortisone is efficacious for the treatment of facial psoriasis 1.

Overall, the most effective topical treatment for psoriasis will depend on the individual patient's needs and the severity of their condition. However, combination treatments with vitamin D analogues and potent topical corticosteroids are a good option for many patients, as they have been shown to be more effective than either agent alone 1.

From the FDA Drug Label

Calcipotriene ointment, 0.005%, is indicated for the treatment of plaque psoriasis in adults. Apply a thin layer of clobetasol propionate gel, cream or ointment to the affected skin areas twice daily and rub in gently and completely.

Topical treatment options for psoriasis include:

• Calcipotriene ointment, 0.005% 2
• Clobetasol propionate gel, cream, or ointment 3 Key considerations:
• Calcipotriene is specifically indicated for plaque psoriasis in adults.
• Clobetasol propionate is a super-high potency topical corticosteroid with limited treatment duration (2 consecutive weeks) and usage guidelines.

From the Research

Topical Treatment Options for Psoriasis

• Corticosteroids, vitamin D analogues, topical retinoids, and calcineurin inhibitors are commonly used first-line topical treatments for mild to moderate psoriasis 4
• The combination of potent and superpotent corticosteroids with vitamin D analogues can provide significant improvement in psoriasis symptoms within 2 weeks, with maximal improvement reached after 4 weeks 4
• Topical therapies containing potent corticosteroids (alone or in combination with a vitamin D analogue) or very potent corticosteroids are highly effective in treating plaque psoriasis 5

Treatment Recommendations

• For patients with less than 20% body surface involvement, topical therapy is the most appropriate choice for initial treatment 6
• Topical treatments combining corticosteroids and vitamin D analogues (administered as fixed combination) are well-established first-line treatments in mild-to-moderate psoriasis 7
• The Tuscany Consensus Group on Psoriasis recommends the use of topical agents such as corticosteroids, vitamin D analogs, keratolytics, and calcipotriol/betamethasone propionate compound for the treatment of mild psoriasis 8

Factors Influencing Treatment Choice

• Disease severity, patient lifestyle, and preferences should be considered when selecting a topical treatment for psoriasis 7
• The clinical effectiveness, fast onset of action, tolerability, cosmetic acceptability, and practicability of topical therapy are important factors in optimizing patient adherence and maximizing efficacy 7
• Good physician-patient communication is also crucial in optimizing patient adherence and treatment outcomes 7