Evidence-Based Review of Topical Treatments for Psoriasis

PURPOSE: To understand the appearance, clinical variation, epidemiology, and patho- physiology of psoriasis and the indications and options for its topical treatment. EPIDEMIOLOGY: Psoriasis occurs in 1% to 3% of the US population. In 20% to 25% of these individuals, the disease will be more than limited. Plaque psoriasis is more common in individuals with haplotypes HLA-B13, -B17, and -Cw6. It worsens with HIV infection, stress, other infection, and exposure to ultraviolet light. REVIEW SUMMARY: Limited plaque psoriasis can be treated effectively with topical thera- pies. The mainstay of treatment is topical corticosteroids, which come in a variety of strengths. Adjustments regarding their sites of application and their durations of use allow prescribers to maximize the therapeutic effects of topical corticosteroids and minimize their side effects for patients. The new sequential administration of calcipotriene and top- ical corticosteroids is an effective treatment; however, older agents such as anthralin, emollients, and keratolytics are useful, as well. Tazarotene, a vitamin A derivative, also is an effective topical agent. TYPE OF AVAILABLE EVIDENCE: Double-blinded randomized trials. GRADE OF AVAILABLE EVIDENCE: Good. CONCLUSION: Mild psoriasis can be treated effectively with topical medication. When the disease is present on more than 20% of the body surface area or has not responded to topical therapy, systemic treatment should be discussed with patient. Research should be directed toward developing more potent medications with fewer side effects that also possess the ability to induce a remission of the disease. (Adv Stud Med. 2004;4(8):420-429)