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Am Fam Physician. 2022;105(5):558-560

This clinical content conforms to AAFP criteria for CME.

Author disclosure: No relevant financial relationships.

Key Points for Practice

• Topical corticosteroids are the most effective topical agent for psoriasis plaques.

• Topical calcineurin inhibitors, vitamin D analogues, and tazarotene are effective and can limit chronic topical corticosteroid use.

• When topical vitamin D analogues are prescribed, avoid vitamin D supplementation, avoid use over large areas, and avoid sun exposure shortly after application.

From the AFP Editors

Psoriasis is a chronic, multisystem inflammatory disorder affecting one out of every 30 people in the United States. In 2021, the American Academy of Dermatology and National Psoriasis Foundation updated their recommendations on topical therapies for patients with mild to moderate psoriasis.

Topical Corticosteroids

Corticosteroids are rated by potency into seven classes (Table 1), with class 1 being the most potent and class 7 being the least potent. Initial treatment with class 2 to 5 agents has the best evidence of benefit, with a number needed to treat (NNT) of 3 for 50% improvement in four weeks and an NNT of 2 with 12 weeks of treatment. Lower-potency products are best used on the face, forearms, and intertriginous areas to avoid adverse effects. Higher-potency agents are reserved for thick, chronic plaques. All corticosteroid products can be used in combination with systemic treatments.

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Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This series is coordinated by Michael J. Arnold, MD, associate medical editor.

A collection of Practice Guidelines published in AFP is available at https://www.aafp.org/afp/practguide.

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