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]) |
* 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.