Designed and created by Guideline Central in participation with the American Academy of Dermatology and National Psoriasis Foundation
Management and treatment of psoriasis with topical therapy and alternative medicine modalities for psoriasis severity measures
Patient Guideline Summary
Publication Date: June 30, 2020
Last Updated: November 1, 2023
Objective
Objective
This patient summary means to discuss key recommendations from the American Academy of Dermatology (AAD) for the management and treatment of psoriasis with topical therapy and alternative medicine modalities. It is limited to adults 18 years of age and older and should not be used as a reference for children.
Overview
Overview
- Psoriasis is an immune-related skin disease associated with a type of arthritis.
- There is no known cause of psoriasis.
- There are many different appearances of psoriasis with names such as vulgaris, plaque, guttate, erythrodermic, pustular, palmoplantar, inverse, and nail.
- Symptoms include a variety of disfiguring skin rashes that itch, burn, bleed and pit fingernails and toenails.
- This patient summary focuses on topical and alternative medicine treatments.
Treatment
Treatment
- There is a dizzying variety of available therapies that can be used alone or in combination, leading to a near infinite treatment arsenal.
- Each treatment has its benefits and its risks. Your doctor will discuss each recommended treatment so that together you can plan the regimen that suits you best.
- New treatments are continuously becoming available and will augment the options that may be recommended.
- Topical steroids are available in 5 strength classes. Your healthcare provider may recommend using mild (class 1), moderate (class 2), or strong (class 3 to five) topical steroids for up to 4 weeks to treat plaque psoriasis, except in skin folds.
- For scalp psoriasis, mild to very strong topical steroids may be used for at least 4 weeks.
- A supervised use of topical steroids for over 12 weeks may be considered.
- Tacrolimus ointment may be recommended off-label (use of a medication for a reason that is not included in the FDA-approved product labeling) to treat psoriasis on the face and in inverse psoriasis (psoriasis of skin folds) for up to 8 weeks.
- Off-label use of pimecrolimus for up to 8 weeks may be recommended for inverse psoriasis.
- Long-term use of these medications may be considered for inverse psoriasis.
- Tacrolimus with salicylic acid may be used off-label for plaque psoriasis.
- Long-term use of vitamin D ointments, such as calcipotriene, is recommended for mild to moderate psoriasis.
- Vitamin D foams or combination products with steroids may be used for scalp psoriasis.
- Tacalcitol or calcipotriene with hydrocortisone can be used for facial psoriasis.
- Combining vitamin D with potent steroids is recommended.
- Applying vitamin D and steroids on alternating days or times can be considered.
- Tazarotene may be used alone for mild to moderate psoriasis or nail psoriasis.
- Tazarotene may be used alone for nail psoriasis.
- It can be combined with light therapy for better efficacy.
- It can be combined with steroids for better efficacy.
- Emollients with topical steroids may help reduce itching, scaling, and flare ups.
- Salicylic acid alone can be used for mild to moderate psoriasis.
- Salicylic acid with steroids can be used for mild to moderate psoriasis.
- Short contact (up to 2 hours per day) anthralin may be used for mild to moderate psoriasis.
- Coal tar is recommended for mild to moderate psoriasis.
- Goeckerman therapy (coal tar and UV light) may also be used.
- Adding topical steroids to oral systemic medications may improve efficacy.
- All topical steroids can be used in combination with any biologics for the treatment of moderate to severe psoriasis.
- Affected body surface area, physician global assessment, itch severity, and quality of life measurements are recommended to assess psoriasis severity.
Abbreviations
- AAD: American Academy Of Dermatology
Source Citation
Elmets CA, Korman NJ, Prater EF, Wong EB, Rupani RN, Kivelevitch D, Armstrong AW, Connor C, Cordoro KM, Davis DMR, Elewski BE, Gelfand JM, Gordon KB, Gottlieb AB, Kaplan DH, Kavanaugh A, Kiselica M, Kroshinsky D, Lebwohl M, Leonardi CL, Lichten J, Lim HW, Mehta NN, Paller AS, Parra SL, Pathy AL, Siegel M, Stoff B, Strober B, Wu JJ, Hariharan V, Menter A. Joint AAD-NPF Guidelines of care for the management and treatment of psoriasis with topical therapy and alternative medicine modalities for psoriasis severity measures. J Am Acad Dermatol. 2021 Feb;84(2):432-470. doi: 10.1016/j.jaad.2020.07.087. Epub 2020 Jul 30. PMID: 32738429.
Disclaimer
The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.