What topical creams are available in Canada for treating psoriasis and dermatitis?

Topical Treatments for Psoriasis and Dermatitis Available in Canada

For psoriasis and dermatitis, topical corticosteroids are the cornerstone of treatment, with calcineurin inhibitors, vitamin D analogs, and emollients serving as important complementary options in Canada.

First-Line Topical Treatments

Topical Corticosteroids

• Superpotent (Class I) corticosteroids like clobetasol propionate 0.05% show 58-92% efficacy rates in psoriasis treatment and are available in various formulations including ointment, cream, foam, and solution 1
• Potent (Class II) corticosteroids like desoximetasone cream and halcinonide solution demonstrate 68-74% efficacy 1
• Mid-strength (Class III-IV) corticosteroids like fluticasone propionate 0.005% ointment and betamethasone valerate foam show 68-72% efficacy 1
• Lower potency (Class V-VII) corticosteroids are available for sensitive areas or for long-term maintenance 1

Calcineurin Inhibitors

• Tacrolimus 0.1% ointment is effective for facial and intertriginous psoriasis with 65% of patients achieving clear or almost clear skin after 8 weeks 1
• Pimecrolimus 0.1% cream shows 71% efficacy for intertriginous psoriasis after 8 weeks of twice-daily application 1
• Both are particularly useful for sensitive areas like face and skin folds where corticosteroid-induced atrophy is a concern 1

Vitamin D Analogs

• Calcipotriene (calcipotriol) is available alone or in combination with betamethasone dipropionate 2
• Combination of calcipotriene with betamethasone dipropionate is particularly effective for reducing nail thickness, hyperkeratosis, and onycholysis in nail psoriasis 2

Retinoids

• Tazarotene 0.1% cream or gel is effective for mild to moderate psoriasis and nail psoriasis 1
• More effective when combined with mid- or high-potency topical corticosteroids for 8-16 weeks than as monotherapy 1

Treatment Algorithms

For Plaque Psoriasis

1. Mild to moderate disease (BSA <5%):

   • Start with mid- to high-potency topical corticosteroid twice daily for 2-4 weeks 1
   • Add emollient to help reduce itching, desquamation, and prevent quick relapse 1
   • Consider combination with calcipotriene for enhanced efficacy 1

2. For maintenance after improvement:

   • Gradually reduce corticosteroid frequency to prevent rebound 1
   • Consider weekend-only application or switching to lower potency agents 1

For Facial and Intertriginous Psoriasis

1. First-line: Topical calcineurin inhibitors (tacrolimus 0.1% ointment or pimecrolimus 0.1% cream) twice daily 1
2. Alternative: Low-potency topical corticosteroids for short-term use only 1

For Nail Psoriasis

1. First-line: Combination of calcipotriene and betamethasone dipropionate 2
2. Alternative: Tazarotene 0.1% cream applied under occlusion 2
3. For nail fold involvement: Mid to high-potency topical corticosteroid ointments or calcineurin inhibitors 3

Important Considerations

Potency Selection

• Match corticosteroid potency to disease severity, body location, and treatment duration 1
• Use higher potency agents for limited periods (2-4 weeks for Class I) 1
• Use lower potency agents for face, intertriginous areas, and in children 1

Side Effects and Precautions

• Common local adverse effects of topical corticosteroids include skin atrophy, striae, folliculitis, telangiectasia, and purpura 1
• Face, intertriginous areas, and chronically treated areas are at greatest risk for adverse effects 1
• Calcineurin inhibitors may cause burning and itching that typically improves with continued use 1
• Tazarotene is contraindicated during pregnancy (Pregnancy Category X) 1
• Avoid simultaneous use of salicylic acid with calcipotriene as the acid pH will inactivate calcipotriene 3

Combination Approaches

• Combining different topical agents can take advantage of varied mechanisms of action 1
• Apply multiple topical agents at separate times throughout the day to avoid compatibility issues 1
• Topical agents can be combined with phototherapy or systemic agents for enhanced efficacy in more severe disease 1

Special Formulations

• Emollient-containing corticosteroid formulations may improve moisture content in treated skin and enhance patient comfort 4
• Clobetasol propionate emollient cream 0.05% is well tolerated and effective for up to 4 weeks for psoriasis treatment 4
• Various vehicles (ointment, cream, foam, solution) affect potency and are selected based on anatomic location and patient preference 5