Topical Treatment for Mild to Moderate Psoriasis

First-Line Therapy

The American Academy of Dermatology recommends a combination of calcipotriene and a mid- to high-potency topical corticosteroid for mild to moderate psoriasis, which provides superior efficacy compared to either agent alone 1, 2
Fixed combination products, such as calcipotriene/betamethasone dipropionate, can be applied once daily for 4-12 weeks 2
Alternating schedule of vitamin D analogue and high-potency topical corticosteroid can be used for maintenance 2
Split dosing of high-potency topical corticosteroid in the morning and vitamin D analogue in the evening can also be effective 2

The American Academy of Dermatology advises against combining calcipotriene with salicylic acid, as the acidic pH inactivates calcipotriene 2, 3
Calcipotriene should be applied after phototherapy sessions, as UVA radiation decreases calcipotriene concentration 2, 3
Long-term use of vitamin D analogues is safe for up to 52 weeks 2

The American Academy of Dermatology recommends applying emollients in conjunction with topical corticosteroids for 4-8 weeks to reduce itching, scaling, and body surface area involvement 1, 4
Emollients can be applied after calcipotriene/corticosteroid combination to avoid washing off active medication 4
Emollients are safe during pregnancy and lactation 1
The risk of contact dermatitis is minimal unless hypersensitivity to ingredients exists 1

Coal tar preparations, such as crude coal tar 0.5-1% in petroleum jelly, can be used for mild to moderate psoriasis, increasing to maximum 10% concentration as tolerated 5, 6
Anthralin (dithranol) can be started at 0.1% concentration, increasing in doubling concentrations as tolerated, and used for up to 2 hours once daily 1, 5, 6
Tazarotene (retinoid) can be applied 0.05-0.1% gel or cream once daily for 8-12 weeks, always combined with mid- to high-potency topical corticosteroid 1, 2, 7

For scalp psoriasis, calcipotriene foam or calcipotriene/betamethasone dipropionate gel can be used for 4-12 weeks 2
For facial/flexural psoriasis, calcipotriene combined with hydrocortisone (low-potency corticosteroid) can be used for 8 weeks 2
For nail psoriasis, calcipotriene/betamethasone dipropionate can be applied to reduce nail thickness, hyperkeratosis, and onycholysis 2, 8

Meditation and mindfulness can improve psoriasis severity in some patients and should be discussed as adjunctive therapy 9
Biofeedback and progressive relaxation techniques may benefit patients with mild psoriasis 9
Hypnosis can be incorporated for highly hypnotizable patients with mild to moderate psoriasis 9

The American Academy of Dermatology recommends contacting a physician if body surface area involvement exceeds 10% (approximately size of 10 palms) 1