Alternative Topical Treatments for Psoriasis

Introduction to Alternative Treatments

The American Academy of Dermatology recommends using betamethasone dipropionate or betamethasone valerate as high-potency corticosteroid alternatives, with combination products containing both a corticosteroid and vitamin D analog showing superior efficacy to either agent alone 1, 2, 3

Coal tar has Level B evidence for efficacy in psoriasis treatment, though less effective than vitamin D analogs 1
Betamethasone dipropionate 0.05% ointment is highly effective, with 26.3% of patients achieving absent to mild disease as monotherapy 2, 3
Other Class I-II corticosteroids have Level A evidence for efficacy in plaque psoriasis 1
Betamethasone dipropionate combined with calcipotriene achieved 48% of patients reaching absent to mild disease versus 26.3% with betamethasone alone 1, 2, 3
Combination therapy with betamethasone dipropionate and calcipotriene resulted in 69-74% of patients achieving clear or almost clear status without serious adverse events 1, 4
Tazarotene gel 0.05% or 0.1% has Level A evidence for efficacy and can be used as a corticosteroid-sparing agent 1
Calcitriol ointment showed comparable efficacy to betamethasone dipropionate 0.05% with better maintenance of remission 4
Tacalcitol is dosed once daily and represents another vitamin D analog alternative 1, 2, 3

Limit high-potency corticosteroids to avoid HPA axis suppression and skin atrophy, particularly with prolonged continuous use 1, 2, 3
The weekend-only maintenance regimen minimizes these risks while maintaining efficacy 1, 2, 3
If vitamin D analogs become available, limit to maximum 100g/week in adults to prevent hypercalcemia 4
Never combine salicylic acid with vitamin D analogs simultaneously, as the acidic pH inactivates calcipotriene/calcipotriol and reduces effectiveness 5, 6
Apply any vitamin D analog alternatives after UV treatment, as UVA radiation decreases calcipotriene concentration on skin 4, 5, 6