What are the topical creams for plaque psoriasis?

From the Guidelines

For plaque psoriasis, the most effective topical treatment is a combination of vitamin D analogs and potent class II and class III topical corticosteroids, as recommended by 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.

Key Considerations

• The long-term use of topical vitamin D analogues, including calcipotriene, calcitriol, tacalcitol, and maxacalcitol, is recommended for the treatment of mild to moderate psoriasis, with a strength of recommendation of A 1.
• Combination products with calcipotriol and corticosteroids are also recommended for the treatment of psoriasis, with a strength of recommendation of A 1.
• The application of vitamin D analogues twice daily on weekdays in conjunction with high-potency topical corticosteroids twice daily on weekends can be considered for maintenance treatment for psoriasis, with a strength of recommendation of B 1.

Treatment Options

• Corticosteroids like betamethasone valerate, triamcinolone, and clobetasol are first-line options, typically applied once or twice daily for 2-4 weeks.
• Vitamin D analogs such as calcipotriene (Dovonex) or calcitriol (Vectical) can be used alone or combined with steroids (as in Enstilar or Taclonex) for better efficacy with reduced side effects.
• Coal tar preparations (2-10% concentration) help slow skin cell growth and reduce inflammation but may stain clothing.
• Salicylic acid (3-6%) helps remove scales before applying other medications.
• Tacrolimus and pimecrolimus are useful for sensitive areas like the face and skin folds.

Maintenance and Prevention

• For maintenance, moisturizers containing urea or lactic acid help prevent dryness and cracking.
• Treatment success varies by individual, and rotation between different agents may prevent tachyphylaxis (decreased response over time).
• Most patients should start with a medium-potency steroid combined with a vitamin D analog for optimal results, applying after gentle exfoliation with a soft cloth during showering.

From the FDA Drug Label

Tazarotene cream 0. 1% is a prescription medicine used on the skin (topical) to treat people with plaque psoriasis. Tazarotene cream, 0.1% is indicated for the topical treatment of patients with plaque psoriasis. The tazarotene cream is used for the topical treatment of plaque psoriasis.

• It is applied 1 time each day, in the evening.
• A thin layer of tazarotene cream should be applied to cover only the psoriasis lesions.
• The skin should be dry before applying the cream.
• A cream or lotion can be used to soften or moisten the skin at least 1 hour before applying tazarotene cream 2. Key points:
• Tazarotene cream is for topical use only.
• It should not be applied to eyes, mouth, or other mucous membranes.
• Patients should avoid excessive sun exposure and use sunscreens and protective measures 2.

From the Research

Topical Creams for Plaque Psoriasis

• Topical corticosteroids and vitamin D analogs are well-established as safe and effective first-line treatments for mild to moderate plaque psoriasis 3.
• The combination of corticosteroids and vitamin D analogs has been shown to have a greater effect on the immune-mediated mechanisms of psoriasis than either monotherapy used alone 3.
• Calcipotriene and betamethasone dipropionate is a common topical combination therapy consisting of a vitamin D analogue and a corticosteroid, which has been consistently shown to be effective and safe in phase II and III clinical trials 4.

Non-Corticosteroid Topical Therapies

• Noncorticosteroid topicals are suitable options for patients with plaque psoriasis who would like to avoid topical corticosteroids or have experienced adverse effects from chronic corticosteroid use 5.
• Six noncorticosteroid topical classes for the treatment of plaque psoriasis were selected, including tacalcitol, calcipotriene/betamethasone dipropionate compound, tazarotene/halobetasol propionate, and roflumilast 5.
• The percentage of patients with plaque psoriasis who achieved Investigator's Global Assessment (IGA) success after 8 weeks of treatment with these noncorticosteroid topicals varied from 17.9% to 42.4% 5.

Treatment Modalities

• Topical corticosteroids have been used for over 50 years to treat mild-to-moderate plaque psoriasis, with treatment duration mostly 4 weeks 6.
• The success rate of topical corticosteroids in treating plaque psoriasis varied from 30% to 90% across parallel group studies, and from 10% to 70% in within-patient studies 6.
• Maintenance intermittent treatment with topical corticosteroids appears to be useful to prolong remission 6.

Clinical Practice

• Maintenance therapy was recommended by dermatologists and general practitioners in 79.1% and 76.8% of cases, respectively 7.
• The use of a fixed-dose combination of corticosteroid and vitamin D analogues was recommended by French and Belgian dermatologists in 54.8% and 39.8% of cases, respectively 7.
• Significant determinants of the therapeutic decision included skin lesions impacting quality of life, patient corticophobia, and the presence of skin pruritus 7.