From the Guidelines
For psoriasis, I recommend starting with topical treatments such as vitamin D analogues (calcipotriene) and corticostercers (hydrocortisone), as they have been shown to be effective in reducing inflammation and normalizing skin cell production, with a recent study 1 demonstrating the efficacy of calcipotriene foam in achieving an Investigator’s Static Global Assessment score of 0 (clear) or 1 (almost clear) in patients with scalp psoriasis. The choice of topical treatment depends on the severity and location of the psoriasis, as well as patient preferences. Some key points to consider when selecting a topical treatment include:
- The use of calcipotriene or tacalcitol ointment combined with hydrocortisone is efficacious for the treatment of facial psoriasis, as noted in a recent study 1.
- Combination treatments with vitamin D analogues and potent topical corticosteroids have been shown to be more effective than either agent alone for the treatment of psoriasis, with a systematic review of RCTs concluding that calcipotriene combined with potent betamethasone dipropionate was slightly more efficacious than betamethasone as a monotherapy 1.
- Ultraviolet A (UVA) radiation can decrease the concentration of calcipotriene on the skin, and thick layers of calcipotriene can block ultraviolet B (UVB), thereby increasing the minimal erythema dose, as discussed in a recent study 1.
- Vitamin D analogues can be used in conjunction with phototherapy, but should be applied after the phototherapy treatment to avoid inactivation by UVA and blocking UVB radiation, as noted in a recent study 1. Other topical treatments that may be effective for psoriasis include:
- Coal tar products (1-5%) to reduce inflammation and slow skin cell growth
- Moisturizers containing salicylic acid to remove scales
- Products with urea to soften thickened skin
- Retinoids (tazarotene/Tazorac) and calcineurin inhibitors (tacrolimus/Protopic) for moderate to severe psoriasis. It is essential to rotate between different treatment types to prevent tolerance and consider combining approaches under medical supervision for stubborn cases, as recommended in a recent study 1.
From the FDA Drug Label
The corticosteroids are a class of compounds comprising steroid hormones secreted by the adrenal cortex and their synthetic analogs. In pharmacologic doses, corticosteroids are used primarily for their anti-inflammatory and/or immunosuppressive effects Topical corticosteroids such as clobetasol propionate are effective in the treatment of corticosteroid-responsive dermatoses primarily because of their anti-inflammatory, antipruritic, and vasoconstrictive actions. Calcipotriene ointment, 0.005%, is indicated for the treatment of plaque psoriasis in adults.
Topical treatments available for psoriasis include: