From the Guidelines
For psoriasis on the limbs, I strongly recommend using a prescription-strength corticosteroid cream such as Clobetasol propionate (Dermovate) or Betamethasone valerate (Betaderm), as they have been shown to provide high efficacy and good safety in the treatment of psoriasis, especially for localized disease 1.
Key Considerations
- Topical corticosteroids are classified into 7 categories based on their skin vasoconstrictive activity, ranging in strength from ultra-high (class 1) to low (class 6 and 7) 1.
- Choosing a corticosteroid with appropriate potency plus the appropriate vehicle should be based on the disease severity, disease location, patient preference, and the age of the patient 1.
- Areas with thick, chronic plaques often require treatment with class 1 (ultrahigh-potency) corticosteroids 1.
Treatment Approach
- Apply a thin layer of the prescribed corticosteroid cream to affected areas once or twice daily for 2-4 weeks, then taper to maintenance use 1.
- For moderate cases, calcipotriol (Dovonex) or a combination product like Dovobet (calcipotriol/betamethasone) may be more effective 1.
- Non-prescription alternatives include moisturizers containing salicylic acid, coal tar, or urea.
Important Precautions
- When using corticosteroids, limit application to 2-4 weeks continuously to avoid skin thinning and rebound effects 1.
- Apply after bathing when skin is slightly damp for better absorption.
- Keeping skin well-moisturized with products like CeraVe or Eucerin between medicated treatments will help maintain improvement.
Additional Options
- Topical tacrolimus may also be considered a first line of therapy for intertriginous psoriasis 1.
- Emollients and ointments are widely used in the treatment of psoriasis, but there is limited evidence that they are beneficial 1.
From the Research
Topical Creams for Psoriasis Treatment
- Halobetasol propionate 0.01% lotion is a recommended treatment for moderate-to-severe plaque psoriasis of the lower extremities, as it provides statistically significant efficacy following 8 weeks of therapy compared to vehicle, with clinically relevant improvements in quality of life 2.
- A combination of calcipotriol and clobetasol propionate as a premixed ointment is also effective for the treatment of psoriasis, with the combination regimen being more efficacious than monotherapy in terms of reduction in eruption score and fewer adverse effects 3.
- Calcitriol ointment and clobetasol propionate cream is another treatment regimen for plaque psoriasis, with calcitriol 3 μg/g ointment providing a safe and effective alternative to calcipotriol 50 μg/g ointment when administered within a regimen based on bitherapy with corticosteroids followed by vitamin D3 maintenance monotherapy 4.
Treatment Recommendations
- 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 5.
- Clobetasol propionate is a common topical therapy used for psoriasis, and its efficacy is similar across different preparations, including ointment, solution, foam, cream, lotion, shampoo, and emollient 6.
Key Findings
- Halobetasol propionate 0.01% lotion provides statistically significant efficacy in the treatment of moderate-to-severe plaque psoriasis of the lower extremities 2.
- Combination therapy with calcipotriol and clobetasol propionate is more efficacious than monotherapy in the treatment of psoriasis 3.
- Calcitriol ointment is a safe and effective alternative to calcipotriol ointment for the treatment of plaque psoriasis 4.