From the Guidelines
Topical treatments for psoriasis include corticosteroids, vitamin D analogs, coal tar preparations, salicylic acid, and calcineurin inhibitors, with the most effective combination being calcipotriene and potent topical corticosteroids, as shown in a 52-week study with 828 patients 1. The choice of topical treatment depends on the severity and location of the psoriasis, as well as patient preferences.
- For mild to moderate psoriasis, topical corticosteroids are the first-line treatment, with options ranging from low-potency (hydrocortisone 1%) for sensitive areas to high-potency (clobetasol propionate 0.05%) for thicker plaques.
- Vitamin D analogs like calcipotriene (Dovonex) can be used alone or with steroids, applied twice daily, and have been shown to be effective in achieving clear or almost clear status in 69% to 74% of patients when combined with betamethasone dipropionate 1.
- Coal tar preparations reduce inflammation and slow cell growth, while salicylic acid helps remove scales.
- For maintenance, moisturizers containing urea or lactic acid help prevent dryness.
- Calcineurin inhibitors (tacrolimus, pimecrolimus) are useful for facial or genital psoriasis. It is essential to start with milder options and progress to stronger ones if needed, and consult a healthcare provider if your psoriasis covers more than 10% of your body or doesn't improve with topical treatments, as recommended by the joint American Academy of Dermatology-National Psoriasis Foundation guidelines of care for the management of psoriasis with systemic nonbiologic therapies 1. The use of combination treatments with vitamin D analogues and potent topical corticosteroids has been shown to be more effective than either agent alone for the treatment of psoriasis, with no serious adverse events observed over a 52-week treatment period 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: