From the Guidelines
Medium potency topical corticosteroids, such as triamcinolone acetonide 0.1%, mometasone furoate 0.1%, fluocinolone acetonide 0.025%, and fluticasone propionate 0.05%, are effective first-line treatments for plaque psoriasis, as they provide a good balance between efficacy and safety. According to the joint AAD-NPF guidelines of care for the management and treatment of psoriasis with topical therapy and alternative medicine modalities for psoriasis severity measures 1, 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).
Key Considerations for Treatment
- Apply these medications thinly to affected areas once or twice daily for 2-4 weeks, then taper to intermittent use (such as weekends only) for maintenance.
- For body lesions, use ointment formulations for better penetration, while creams may be preferred for scalp, face, or intertriginous areas.
- Limit continuous use to 2-4 weeks to avoid side effects like skin thinning, striae, and tachyphylaxis.
- These steroids work by reducing inflammation, suppressing T-cell activation, and decreasing keratinocyte proliferation—all key factors in psoriasis pathophysiology.
Combination Therapy and Maintenance
- Consider using them in combination with vitamin D analogs (like calcipotriene) or under occlusion for enhanced efficacy in stubborn plaques.
- For maintenance, consider transitioning to weekend-only steroid application or alternating with non-steroidal treatments to minimize long-term side effects while maintaining disease control, as supported by the guidelines 1.
Evidence-Based Recommendation
The recommendation for medium potency topical corticosteroids is based on the most recent and highest quality study available, which emphasizes their efficacy and safety in the treatment of plaque psoriasis 1.
From the FDA Drug Label
Topical corticosteroids are generally applied to the affected area as a thin film from two to three times daily depending on the severity of the condition. INDICATIONS AND USAGE: Topical corticosteroids are indicated for the relief of the inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses.
Medium potency steroids for treating plaque psoriasis include:
- Triamcinolone acetonide 2
- Betamethasone valerate 3 are examples of topical corticosteroids that can be used to treat plaque psoriasis.
From the Research
Medium Potency Steroids for Treating Plaque Psoriasis
- Medium potency steroids are used to treat plaque psoriasis, especially for localized lesions or residual lesions after systemic treatment 4, 5
- Triamcinolone acetonide is a commonly used medium potency steroid for treating plaque psoriasis, and it can be administered intralesionally or topically under occlusion 4, 5, 6
- Intralesional triamcinolone acetonide has been shown to be effective in treating localized plaque psoriasis, with a complete clearance rate of 62.5% in one study 4
- Topical triamcinolone acetonide 0.1% under occlusion with hydrocolloid dressings has also been shown to be effective in treating chronic plaques of psoriasis, with a total clearance rate of 52-59% in one study 6
- The use of medium potency steroids, such as triamcinolone acetonide, can be a useful treatment option for patients with plaque psoriasis, especially those who are not suitable for systemic agents or have localized lesions 4, 5
Comparison of Medium Potency Steroids with Other Treatments
- Medium potency steroids have been compared with other treatments, such as 5-fluorouracil, in the treatment of plaque psoriasis, and have been shown to have a higher response rate and fewer side effects 4
- The efficacy of medium potency steroids in treating plaque psoriasis has also been compared with other topical corticosteroids, and has been shown to be effective in achieving significant improvement in psoriasis severity 7
- However, the choice of treatment for plaque psoriasis depends on various factors, including the severity of the disease, the location and size of the lesions, and the patient's medical history and preferences 7, 8