What cream is used to treat psoriasis?

Topical Treatment Options for Psoriasis

For mild to moderate psoriasis, topical corticosteroids are the first-line treatment, with vitamin D analogs (like calcipotriene) and calcineurin inhibitors (for face/intertriginous areas) as effective alternatives or combination therapies. 1, 2

First-Line Topical Treatments

Topical Corticosteroids

• Potency classes:

  • Class 1 (Ultrahigh-potency): Clobetasol propionate, Halobetasol propionate
  • Class 2-5 (High to moderate potency): Betamethasone dipropionate, Triamcinolone acetonide
  • Class 6-7 (Low potency): Hydrocortisone, Desonide 2

• Application:

  • Apply to affected areas 2-3 times daily 3
  • For psoriasis, occlusive dressings may enhance efficacy 3
  • Limit high-potency use to 4 weeks to prevent skin atrophy 2

• Efficacy:

  • Provide rapid symptom relief within 2 weeks 4
  • Potent and very potent corticosteroids are more effective than mild/moderate ones 1
  • For maintenance, consider weekend-only application to prevent tachyphylaxis 4

Vitamin D Analogs (Calcipotriene)

• FDA-approved for plaque psoriasis in adults 5
• Can be used as monotherapy or in combination with corticosteroids 2
• Maximum 100g weekly to avoid hypercalcemia 2
• Takes 6-8 weeks for full effectiveness 4

Special Anatomical Considerations

Facial and Intertriginous Areas

• First choice: Tacrolimus 0.1% ointment 1
  • Achieves clearance or excellent improvement within 30 days 1
  • No risk of skin atrophy unlike corticosteroids 2
  • May cause initial burning sensation 2
• Alternative: Low-potency corticosteroids 2

Scalp Psoriasis

• Medicated shampoos containing coal tar, salicylic acid 2
• Solutions or foams of corticosteroids 2
• Betamethasone valerate foam showed 72% improvement in moderate to severe scalp psoriasis 1
• Fluocinolone acetonide 0.01% oil showed 83% good or better improvement for severe scalp psoriasis 1

Combination Approaches

Corticosteroid + Vitamin D Analog

• More effective than either agent alone 1
• Options:
  1. Apply separately (one in morning, one in evening)
  2. Mix 1:1 on finger and apply together
  3. Use commercial combination product 1
• After initial control (2 weeks), can reduce to corticosteroids on weekends and vitamin D analog on weekdays 1

Corticosteroid + Tazarotene

• Tazarotene combined with mid/high-potency corticosteroid for 8-16 weeks is more effective than tazarotene alone 1
• Decreases treatment duration and increases remission length 1
• Helps reduce tazarotene-induced irritation 6

Treatment Algorithm Based on Severity and Location

1. Mild psoriasis (< 3% BSA):

   • Start with mid-potency topical corticosteroid twice daily for 2-4 weeks
   • Add calcipotriene if inadequate response after 2 weeks
   • For maintenance: weekend-only corticosteroid application

2. Moderate psoriasis (3-10% BSA):

   • Combination therapy: corticosteroid + calcipotriene
   • Consider rotation therapy to minimize side effects

3. Special areas:

   • Face/intertriginous: Tacrolimus 0.1% ointment or low-potency corticosteroid
   • Scalp: Corticosteroid solution/foam or medicated shampoo
   • Thick plaques: Add salicylic acid to increase penetration 6

Important Considerations

• Treatment evaluation: Assess response after 4 weeks 2
• Monitoring: Watch for skin atrophy, telangiectasia, and striae with corticosteroids 2
• Limitations: Psoriasis invariably recurs after discontinuation of topical corticosteroid treatment, with mean remission duration of 2 months 1
• Tachyphylaxis: May occur with continued use of corticosteroids 1

Common Pitfalls to Avoid

1. Using high-potency corticosteroids on face/intertriginous areas (risk of atrophy)
2. Continuous long-term use of potent corticosteroids (limit to 4 weeks)
3. Using calcipotriene alone when combination therapy would be more effective
4. Neglecting maintenance therapy after clearing (leads to rapid relapse)
5. Using coal tar or anthralin as first-line therapy (limited benefit compared to newer options) 7

When topical therapies fail to provide adequate control, consider adding phototherapy or systemic treatments for moderate-to-severe disease 2.