Drug class/drug(s)	Mechanism of action	Dosage	Common side effects	Cost (generic)*		Comment
Topical steroids
Various potent or very potent topical steroids (e.g., mometasone [Elocon], clobetasol [Temovate])	Controls inflammation	Mometasone: 0.1% cream, ointment, lotion; applied once a day	Hypopigmentation, striae, skin atrophy, tachyphylaxis	Mometasone: Cream, ointment: 45 g, $54 ($45 to $49) Lotion: 60 mL, $61		Side effects increase with longer duration of use and occlusive dressings.
		Clobetasol: 0.05% cream, ointment, gel, solution; applied twice a day		Clobetasol: Cream, ointment: 45 g, $80 ($47 to $50) Gel: 60 g, $100 ($72 to $74) Solution: 25 mL, $36 ($27 to $28)
Vitamin D derivatives
Calcipotriene (Dovonex)	Normalizes keratinocyte proliferation and differentiation	0.005% cream, ointment, solution; applied twice a day	Skin irritation, pruritus, burning, hypercalcemia	Cream: 60-g tube, $132; 120-g tube, $241 Solution: 60-mL bottle, $116 Ointment: 60-g tube, $132; 120-g tube, $241		Limit dosage to 100 g per week to avoid hypercalcemia.
Topical retinoids
Tazarotene (Tazorac)	Normalizes keratinocyte proliferation and differentiation	0.05%, 0.1% cream, gel; applied at bedtime	Skin irritation, pruritus, burning/stinging, erythema, desquamation, teratogenicity	Cream, 0.05%: 30 g, $100; 60 g, $200; 0.1%: 30 g, $106; 60 g, $213 Gel, 0.05%: 100 g, $334; 0.1%: 100 g, $354		Obtain negative pregnancy test within two weeks of starting treatment.
Topical immunosuppressants
Tacrolimus (Prograf)†	Inhibits T-lymphocyte cell activation	0.1%, 0.3% ointment; applied once or twice a day	Burning/stinging, pruritus, influenza-like symptoms, erythema, acne, folliculitis, HSV infection	0.1%: 30 g, $68 0.1%: 60 g, $136 0.1%: 100 g, $209		Studies cited used 0.3% ointment every day and 0.1% ointment twice a day.
Pimecrolimus (Elidel)†	Inhibits T-lymphocyte cell activation	1% cream; applied twice a day	Burning, pruritus, influenza-like symptoms, erythema, HSV infection, viral infection, fever	30 g, $57 60 g, $113 100 g, $178		Study cited used 1% cream twice a day.
Anthralin (Anthra-Derm)	Antiproliferative effect on epidermal keratinocytes	0.1%, 0.25%, 0.5%, 1% cream, ointment; applied once or twice a day	Skin irritation, erythema, staining (skin and clothing), odor	Anthra-Derm cream, 1%: 50 g, $88 ($59)
Coal tar
Multiple preparations exist Zetar topical ointment	Keratolytic and probably anti-inflammatory and antiproliferative effects	Coal tar solution 10% = 2% coal tar; applied at bedtime	Skin irritation, folliculitis, odor, staining of clothing	3.8 oz, $9 to $13