From the Guidelines
For mild to moderate psoriasis, the most effective treatment is a combination of topical corticosteroids and vitamin D analogs, such as calcipotriene and betamethasone dipropionate, as evidenced by a 52-week study with 828 patients, where 69% to 74% of patients achieved clear or almost clear status 1.
Key Considerations
- Topical corticosteroids, such as betamethasone valerate or clobetasol propionate, are often first-line treatments for mild to moderate psoriasis, applied thinly to affected areas once or twice daily for 2-4 weeks.
- Vitamin D analogs like calcipotriene (Dovonex) can be used alone or combined with steroids for better efficacy.
- Combination products with calcipotriene and corticosteroids are recommended for the treatment of psoriasis, with a strength of recommendation of A 1.
- The use of calcipotriene or tacalcitol ointment combined with hydrocortisone is efficacious for the treatment of facial psoriasis.
Treatment Options
- Topical corticosteroids: superpotent (class I), potent (class II), midstrength (class III and IV), and least potent (class V, VI, and VII) options are available, with varying efficacy rates ranging from 41% to 92% 1.
- Vitamin D analogs: calcipotriene, calcitriol, tacalcitol, and maxacalcitol are effective for the treatment of mild to moderate psoriasis, with a strength of recommendation of A 1.
- Combination treatments: calcipotriene and betamethasone dipropionate, calcipotriene and hydrocortisone, and other combinations are effective for the treatment of psoriasis.
Important Considerations
- The use of topical corticosteroids should be limited to 2-4 weeks to minimize the risk of cutaneous side effects and systemic absorption.
- A gradual reduction in the frequency of usage following clinical response is recommended, although the exact details of this tapering are not well established.
- Patient preference, age, and presence or absence of occlusion can alter the efficacy of topical corticosteroids.
From the FDA Drug Label
Calcipotriene ointment, 0.005%, is indicated for the treatment of plaque psoriasis in adults.
- Calcipotriene ointment is a treatment option for psoriasis in adults 2.
- It is specifically indicated for the treatment of plaque psoriasis.
- Triamcinolone acetonide can be used for the management of psoriasis, but the label does not specify it is only for psoriasis 3.
From the Research
Psoriasis Ointment Overview
- Psoriasis is a chronic inflammatory skin disease that affects millions of people worldwide, with no cure available, but various treatment options exist 4.
- Topical therapies, including vitamin D analogs and corticosteroids, are the mainstay for patients with limited or mild psoriasis 4, 5.
Topical Corticosteroids
- Topical corticosteroids are available in many vehicles, including sprays, which offer convenience and strong efficacy 6.
- Studies have shown that topical corticosteroid sprays, such as clobetasol propionate and desoximetasone, are effective in treating moderate-to-severe plaque psoriasis 6.
- Adverse events, including burning, irritation, and dryness, are similar across all corticosteroids 6.
Combination Therapies
- Combination therapies, including topical agents with biologics, conventional systemic agents, and phototherapy, have been shown to provide clinical benefits in the treatment of psoriasis 4, 7.
- Calcipotriol ointment, a vitamin D3 analog, has been shown to be effective in combination with other antipsoriatic agents, reducing the dosage and/or duration of these treatments and potentially improving their benefit/risk ratio 7.
Treatment Modalities
- The optimal modalities of administration of topical corticosteroids in psoriasis, including influence of steroid potency, topical formulation, occlusion procedure, and rate of application, are not well established 8.
- Maintenance intermittent treatment with topical steroids appears to be useful in prolonging remission in patients with plaque psoriasis 8.