Challenges With Topical Psoriasis Treatments and the Need for Simpler Options

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EP: 1.Challenges With Topical Psoriasis Treatments and the Need for Simpler Options

EP: 2.Why Treating Scalp Psoriasis With Topicals Remains a Challenge

Topical therapies remain a foundational component in the management of psoriasis, regardless of disease severity or body surface area involvement. Whether used as monotherapy for mild cases or adjunctively alongside systemic agents for more severe disease, topicals are essential. Current treatment guidelines continue to support their use across all levels of psoriasis. Despite the excitement surrounding new systemic therapies, most patients have limited disease that can often be effectively managed with topical treatments if used correctly and consistently.

However, topical therapies have historically posed several challenges. Steroidal topicals, although effective, often come with limitations in duration of use, safety concerns in sensitive areas such as the face or intertriginous zones, and the need for multiple products for different body regions. Nonsteroidal alternatives, although promising in theory, have often fallen short due to tolerability issues or less-than-expected efficacy. These complexities lead to adherence issues, as patients frequently misuse or misapply medications, sometimes leading to adverse effects such as atrophy or telangiectasia. The resulting confusion and fear surrounding topicals—especially steroids—underscore the need for streamlined treatment regimens.

Simplification is a major priority in improving adherence and outcomes. Patients are often overwhelmed when prescribed multiple topicals, particularly when unclear instructions lead to misuse. A single, effective, well-tolerated topical agent that can be used across all affected areas—head to toe and in all age groups—would be a significant advancement. Moreover, there is a growing hesitancy among patients, particularly in the pediatric population and among those with atopic tendencies, to use steroids. As a result, the dermatology community continues to seek safer, nonsteroidal options that maintain efficacy without compromising safety or ease of use. Reducing complexity and addressing topical steroid fears will be key to empowering patients and achieving better control of psoriasis.