What ointment is effective for treating mild to moderate psoriasis?

Topical Corticosteroids Are First-Line Treatment for Mild to Moderate Psoriasis

For mild to moderate plaque psoriasis, topical corticosteroids of class 1-5 (high to medium potency) are recommended as first-line treatment for up to 4 weeks, with selection based on disease location and severity. 1

Treatment Algorithm for Mild to Moderate Psoriasis

First-Line Options:

1. Topical Corticosteroids

   • For body plaques (non-intertriginous areas):

     • Use class 1-5 (high to medium potency) corticosteroids 1
     • Apply once or twice daily for up to 4 weeks
     • For thick, chronic plaques: Class 1 (ultrahigh-potency) corticosteroids
     • For moderate plaques: Class 2-5 (high to medium potency)

   • For sensitive areas (face, intertriginous regions, forearms):

     • Use lower potency corticosteroids (class 6-7) to minimize adverse effects 1

   • For scalp psoriasis:

     • Any class (1-7) corticosteroid can be used for at least 4 weeks 1

2. Vitamin D Analogues

   • Calcipotriene 0.005% (FDA-approved for plaque psoriasis) 2
   • Can be used alone or in combination with corticosteroids
   • Takes longer to show efficacy (6-8 weeks) compared to corticosteroids (2-4 weeks) 3

Combination Approaches:

1. Corticosteroid + Vitamin D Analogue

   • More effective than either agent alone 1
   • Morning application of high-potency corticosteroid and evening application of vitamin D analogue 1
   • Avoid using salicylic acid with calcipotriene (acid pH inactivates calcipotriene) 1

2. Corticosteroid + Tazarotene

   • Mid or high-potency corticosteroid with tazarotene for 8-16 weeks 1
   • Reduces irritation from tazarotene while limiting steroid-induced atrophy
   • Increases duration of treatment effect and remission time

Important Considerations

Corticosteroid Selection:

• Potency: Choose based on severity, location, and patient age
• Vehicle: Ointments for thick plaques, creams for less thick lesions, foams/sprays for scalp and hairy areas 4, 5
• Efficacy rates: Class 1 (ultrahigh-potency) corticosteroids show 58-92% improvement in clinical trials 1

Duration and Tapering:

• Initial treatment: Up to 4 weeks 1
• Long-term use (>12 weeks): Only under careful physician supervision 1
• After improvement: Gradually reduce frequency (weekend-only application may be effective for maintenance) 3

Monitoring for Adverse Effects:

• Common adverse effects: Skin atrophy, striae, telangiectasia, folliculitis, purpura 1
• High-risk areas: Face, intertriginous areas, forearms
• Other concerns: May exacerbate acne, rosacea, perioral dermatitis, and tinea infections
• Rebound phenomenon: Disease may recur more severely after abrupt discontinuation 1

Special Situations:

• Intertriginous areas: Consider topical calcineurin inhibitors (tacrolimus, pimecrolimus) as steroid-sparing agents 1
• Thick, resistant plaques: Consider intralesional corticosteroids (triamcinolone acetonide up to 20 mg/mL every 3-4 weeks) 1, 6
• Maintenance therapy: Intermittent application (weekend-only) can prolong remission 7

Treatment Success Factors

• Treatment success rates vary widely across studies (7-85% achieving 75% improvement) 7
• Occlusive dressings can improve efficacy for recalcitrant psoriasis 6
• Patient adherence is critical - consider vehicle preferences and application frequency 4

The evidence strongly supports topical corticosteroids as the cornerstone of treatment for mild to moderate psoriasis, with vitamin D analogues as important adjuncts or alternatives. Treatment should be tailored based on disease location and severity, with careful attention to potential adverse effects with prolonged use.