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Topical therapies for chronic plaque psoriasis in adults*

Topical therapies for chronic plaque psoriasis in adults*
Name Formulations Standard initial application frequency
Topical corticosteroids Multiple Twice dailyΔ
Topical calcineurin inhibitors
Tacrolimus 0.1% ointment Twice daily
Pimecrolimus 1% cream Twice daily
Topical phosphodiesterase 4 inhibitor
Roflumilast 0.3% cream Once daily
Topical retinoid
Tazarotene 0.05% cream or gel, 0.1% cream or gel Once daily in evening
Topical vitamin D analogs
Calcipotriene (calcipotriol) 0.005% cream, foam, ointment, or solution Twice dailyΔ
Calcitriol 3 mcg/g ointment Twice daily (do not exceed 200 g weekly)Δ
Topical aryl hydrocarbon receptor agonist§
Tapinarof 1% cream Once daily
Combinations
Halobetasol 0.01% and tazarotene 0.045% Lotion Once daily (not to exceed 50 g/week)
Calcipotriene 0.005% and betamethasone 0.064% Cream, foam, gel, ointment, suspension (gel not available in the United States) Once daily (not to exceed 100 g/week [foam formulation not to exceed 60 g every 4 days])
For approach to therapy including agent selection, appropriate sites for application, and expected time for response, refer to UpToDate content on treatment of chronic plaque psoriasis in adults.

* Limited to drugs commercially available in the United States.

¶ For maintenance regimens and use of adjunctive topical agents (eg, emollients, salicylic acid), refer to UpToDate content on treatment of chronic plaque psoriasis in adults.

Δ If separate topical corticosteroid and vitamin D analog products are prescribed for patients receiving combination topical corticosteroid and topical vitamin D analog therapy, one product (eg, vitamin D analog) is typically used once daily in the morning, and the other (eg, corticosteroid) is typically used once daily in the evening.

◊ Topical calcineurin inhibitors are generally reserved for intertriginous, genital, or facial plaques as primary therapy or as corticosteroid-sparing therapy.

§ Topical coal tar is an additional treatment that may work through this mechanism. Coal tar is primarily used as adjunctive treatment.
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