The Foundation of Psoriasis Tx: Talking Topical Therapy With Linda Stein Gold, MD

Despite the continued advancement of systemic therapies, topical treatment remains the foundation of psoriasis management, Linda Stein Gold, MD, said in an interview with Dermatology Times at the DERM 2025 NP PA CME Conference in Las Vegas, Nevada.

“The vast majority of [patients] are either treated with topical therapy alone, or they’re using topical therapy concomitantly with their systemic medications,” said Stein Gold, director of dermatology clinical research and division head of dermatology at the Henry Ford Health System in in Michigan. “So it really still is the foundation of treatment of psoriasis.”

Historically, topical corticosteroids have dominated the treatment landscape, she explained. For instance, really potent topical steroids like clobetasol are good for flares, triamcinolone cream is appropriate for maintenance therapy, and desonide or hydrocortisone can be used for sensitive areas.

Unfortunately, with all the agents prescribed, patients may feel overwhelmed, which can lead to polypharmacy confusion, Stein Gold added. “When you think about all the prescriptions that we're writing—maybe we're using some of the traditional non-steroidals—patients end up with all these prescriptions and they are almost incapacitated by fear because there's so many things to do. They forget what they're supposed to do,” she said.

Although potent steroids offer rapid symptom relief, Stein Gold said they are not a sustainable solution. “I think of them as a short-term answer to a long-term solution or really like a band-aid,” she said. Long-term use can thin the skin, disrupt the barrier, and increase transepidermal water loss.

Fortunately, non-steroidal options are becoming more viable. Stein Gold pointed to tapinarof, an aryl hydrocarbon receptor agonist, which has demonstrated durability of response. “You can use it on the face, you can use it on the hands, you can use it on thick areas,” she said. “If you treat these patients until clear, you have a durable remission that can last even four months or longer.”

She also spotlighted topical roflumilast in discussing phosphodiesterase type 4 (PDE4) inhibitors. “We've seen PDE4 inhibitors in the past, but this one's different,” she told Dermatology Times. “It's very potent. It's a topical, and it also can be used as monotherapy.”

The foam version was recently approved, she said. “What's nice with that is there's one vehicle that can be used on the scalp as well as on the body.”

Importantly, these newer agents are well tolerated, she said. “tolerability is so important because if you give somebody something that stings and burns, chances are they might use it a little bit, but they're probably not going to be really good about treating in the long-term.”

Looking ahead, Stein Gold sees room for growth. “Still not 100% of patients are getting [their symptoms] under control,” she said. “If we can get some new drugs with new mechanisms of action, I think that would be great.”

Reference

1. Stein Gold L. Psoriasis Topicals: Totally Tubular. Presented at DERM 2025 NP PA CME Conference; July 23-26, 2025; Las Vegas, Nevada.