From the Guidelines
Topical corticosteroid creams are a highly effective treatment for psoriasis, with efficacy rates ranging from 41% to 92%, and should be used as first-line therapy for mild to moderate disease. When selecting a topical corticosteroid, consider the potency, vehicle, and patient preferences, as these factors can significantly impact treatment outcomes 1. For mild to moderate psoriasis, a medium-potency steroid such as triamcinolone 0.1% or mometasone furoate 0.1% can be used, applying a thin layer to affected areas once or twice daily for 2-4 weeks.
Some key points to consider when using topical corticosteroids for psoriasis include:
- Higher-potency steroids, such as clobetasol propionate 0.05%, may be needed for more severe cases, but should be limited to 2 weeks of use due to increased risk of side effects 1
- Gradually taper use by decreasing frequency before stopping to prevent rebound flares
- Apply creams after bathing when skin is slightly damp for better absorption
- Be cautious with long-term use, especially on thin skin areas like the face, groin, or armpits, as steroids can cause skin thinning, stretch marks, and increased hair growth
- Consider alternating with non-steroid treatments like calcipotriene (vitamin D analog) or using the steroid only during flares
The most recent and highest quality study, published in 2021, supports the use of topical corticosteroids as a key component of psoriasis treatment, with ultrahigh-potency corticosteroids demonstrating efficacy rates of 58% to 92% 1. Overall, topical corticosteroid creams are a safe and effective treatment option for psoriasis, and their use should be tailored to individual patient needs and preferences.
From the FDA Drug Label
Topical corticosteroids share anti-inflammatory, antipruritic and vasoconstrictive actions. The mechanism of anti-inflammatory activity of the topical corticosteroids is unclear. Various laboratory methods, including vasoconstrictor assays, are used to compare and predict potencies and/or clinical efficacies of the topical corticosteroids There is some evidence to suggest that a recognizable correlation exists between vasoconstrictor potency and therapeutic efficacy in man.
The role of topical corticosteroid cream in the treatment of psoriasis is to provide anti-inflammatory and antipruritic effects. Although the exact mechanism of action is unclear, topical corticosteroids are used to reduce inflammation and itching associated with psoriasis. Key points include:
- Anti-inflammatory actions to reduce swelling and redness
- Antipruritic actions to relieve itching
- Vasoconstrictive actions to reduce blood flow to the affected area 2
From the Research
Role of Topical Corticosteroid Cream in Psoriasis Treatment
- Topical corticosteroids are a mainstay treatment for mild to moderate psoriasis, often used in combination with other therapies such as vitamin D analogs 3, 4, 5.
- The efficacy of topical corticosteroids in treating psoriasis has been demonstrated in various studies, with response rates varying from 30% to 90% of patients achieving more than 50% improvement in psoriasis severity 6.
- Topical corticosteroids can be used as a maintenance treatment to prolong remission, with intermittent application shown to be effective in reducing the frequency of applications and minimizing side effects 5, 6.
- The choice of topical corticosteroid potency, formulation, and application frequency can impact treatment outcomes, although the optimal treatment modalities are not well established due to variability in study designs and outcomes 6, 7.
- Network meta-analyses have ranked the efficacy of different topical treatments, with potent and very potent corticosteroids dominating the treatment hierarchy for both trunk and limb, and scalp psoriasis 7.
Treatment Modalities and Efficacy
- Topical corticosteroids can be applied once or twice daily, with no significant difference in efficacy observed between these regimens 7.
- Combination therapy with vitamin D analogs and corticosteroids can enhance treatment outcomes, although the added benefit of combination therapy is not universally established 3, 5, 7.
- Occlusion dressing can provide additional benefit in enhancing the efficacy of topical corticosteroids 6.
- Long-term safety and efficacy data on topical corticosteroids are limited, with most studies evaluating treatment outcomes over a short period (e.g., 4-8 weeks) 6, 7.