Psoriasis is a chronic, inflammatory, multisystem disease. A guideline provides recommendations for its treatment based on the available evidence. 

Topical corticosteroids are classified into 7 categories according to their skin vasoconstrictive activity.

Recommendations for topical corticosteroids-

• For the treatment of plaque psoriasis not involving intertriginous areas, a recommendation is for using class 1, class 2, and class 3-5 topical corticosteroids for up to 4 weeks
• As initial and maintenance treatment of scalp psoriasis, a recommendation is for using class 1-7 topical corticosteroids for a minimum of up to 4 weeks
• Under the careful supervision of a physician, topical corticosteroids can be used for 12 weeks

Recommendations for topical pimecrolimus and tacrolimus 

• For psoriasis involving the face and inverse psoriasis, 0.1% tacrolimus can be used off-labelled for up to 8 weeks
• For inverse psoriasis, pimecrolimus can be used off-labelled for 4-8 weeks is recommended
• For inverse psoriasis treatment, Long-term use of tacrolimus or pimecrolimus can be considered as off-label use
• For the treatment of plaque psoriasis, a combination of tacrolimus and 6% salicylic acid for 12 weeks can be considered as off-label use 

Recommendations for vitamin D analogues

• For the treatment of mild to moderate psoriasis, a recommendation is for the long-term use of topical vitamin D analogues (up to 52 weeks), including calcipotriene/ calcipotriene, calcitriol, tacalcitol, and maxacalcitol.
• For the treatment of mild to moderate scalp psoriasis, a recommendation is for using calcipotriene foam and calcipotriene plus betamethasone dipropionate gel is recommended for 4-12 weeks  
• For the treatment of facial psoriasis, Topical tacalcitol ointment or calcipotriene combined with hydrocortisone can be used for 8 weeks
• Treatment of psoriasis is recommended with combination treatments with vitamin D analogues and potent class II and class III topical corticosteroids up to 52 weeks
• Treatment of psoriasis is recommended with combination products with calcipotriol and corticosteroids
• For maintenance treatment for psoriasis B, 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 the treatment of psoriasis B, the application of morning high-potency topical corticosteroids and evening topical vitamin D analogues is an effective treatment regimen that can be considered 

Recommendations for topical tazarotene 

• Mild to moderate psoriasis can be treated with Topical tazarotene
• Nail psoriasis can be treated with Topical tazarotene
• The combination of topical tazarotene and NB-UVB is effective and allow a reduction in the total use of NB-UVB
• For the treatment of mild to moderate psoriasis, a recommendation is for using mid- or high-potency topical corticosteroid in combination with tazarotene for 8- 16 weeks as it is more effective than monotherapy with tazarotene
• To decrease the duration of treatment as well as increase the length of remission a recommendation is for using topical corticosteroids along with tazarotene.

Recommendations for emollient 

• An emollient can be used with topical corticosteroids for 4 to 8 weeks to help reduce itching, desquamation, and total body surface area and prevent quick relapse of psoriasis when topical corticosteroids are discontinued

Recommendation for salicylic acid  

• Mild to moderate psoriasis can be treated with Topical salicylic acid for 8-16 weeks
• Moderate to severe psoriasis (body surface area </=20%) can be treated with a combination of salicylic acid with topical corticosteroids

Recommendation for topical anthralin 

• Mild to moderate psoriasis can be treated with Topical anthralin for 8- 12 weeks with Short contact (up to 2 hours per day) to limit adverse side effects

Along with, the Recommendations for coal tar, the combination of topical agents with biologics, the combination of topical calcipotriene and methotrexate, combination of topical agents and cyclosporine, combination of calcipotriene and acitretin, body surface area (BSA) severity measure, Psoriasis Area and Severity Index (PASI ) severity measure, the Physician Global Assessment (PGA) severity measure, Physician Global Assessment (PGA) 3 body surface area (BSA) severity measure, Psoriasis Symptom Inventory (PSI ) severity measure, the Dermatology Life Quality Index (DLQI ) severity measure, pruritus assessment severity measure were also given.

Source: JAAD, 2020;84(2):432-470.DOI:https://doi.org/10.1016/j.jaad.2020.07.087