What is the best topical cream for facial psoriasis?

Best Topical Cream for Facial Psoriasis

For facial psoriasis, tacrolimus 0.1% ointment is the recommended first-line topical agent, with calcipotriene combined with low-potency corticosteroids (such as hydrocortisone) as an effective alternative. 1

Primary Recommendation: Topical Calcineurin Inhibitors

Tacrolimus 0.1% ointment is specifically recommended for facial psoriasis because the face is a vulnerable area where higher-potency corticosteroids carry significant risk of skin atrophy and other adverse effects. 1

• Studies demonstrate rapid efficacy, with complete clearance achieved within 72 hours to 2 weeks in facial psoriasis patients. 1
• Tacrolimus is preferred as first-line therapy for psoriasis of the face, genitalia, and body folds according to systematic reviews. 1
• The main side effect is transient burning and stinging at the application site, which is generally well-tolerated. 1

Alternative Option: Vitamin D Analogues with Low-Potency Corticosteroids

Calcipotriene (or tacalcitol) combined with hydrocortisone for 8 weeks is an effective treatment for facial psoriasis (Strength of Recommendation B). 1

• An 8-week RCT demonstrated that calcipotriene combined with hydrocortisone was more effective on facial lesions than calcipotriene alone, with significantly better clearance rates (odds ratio 2.01). 1
• This combination provides anti-inflammatory effects while minimizing the atrophy risk associated with higher-potency steroids on facial skin. 1

Important Caveats for Facial Treatment

Lower potency corticosteroids must be used on the face due to increased susceptibility to steroid-induced atrophy, telangiectasia, and other adverse effects in this anatomically sensitive area. 1

• High- or ultra-high-potency corticosteroids (class 1-2) should be avoided on facial skin. 1
• If corticosteroids are used on the face, limit to low-potency agents (class 6-7) and short durations. 1

Treatment Algorithm for Facial Psoriasis

1. First-line: Start with tacrolimus 0.1% ointment applied to facial lesions. 1

2. If tacrolimus causes intolerable burning: Switch to calcipotriene combined with hydrocortisone for 8 weeks. 1

3. For maintenance: Continue with the agent that achieved clearance, using intermittent application to maintain remission. 1

4. Avoid: High-potency topical corticosteroids, salicylic acid (which inactivates calcipotriene), and prolonged continuous use of any single agent. 1