Topical psoriasis therapy in the age of biologics: evidence-based treatment recommendations.
BACKGROUND
Although the range of therapeutic options has expanded dramatically in recent years, topical agents remain ubiquitous and indispensable tools for treating psoriasis at all levels of severity. The 2009 Canadian psoriasis guidelines considered evidence supporting various monotherapies and combination regimens.


OBJECTIVE
Here we review all approved topical agents, including corticosteroids, calcineurin inhibitors, vitamin D analogues, and retinoids, used in psoriasis and develop additional treatment recommendations, using the Scottish Intercollegiate Guidelines Network (SIGN) system to evaluate strength of evidence, as in the original guidelines.


CONCLUSIONS
We propose that topical treatments have a place in the long-term management of patients with moderate to severe plaque psoriasis, including those receiving concomitant photo- or systemic therapy. Topical agents are effective and appropriate treatments for psoriasis as long as the physician is attentive to signs of local adverse events and seeks opportunities to reduce the dose or treatment frequency during chronic use.
Guildford Dermatology, Surrey, BC, Canada. lalbrecht@primus.ca
Lorne
L
Albrecht
Marc
M
Bourcier
John
J
Ashkenas
Kim
K
Papp
Neil
N
Shear
John
J
Toole
Ronald
R
Vender
Norman
N
Wasel
D000287:Administration, Topical; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000627:therapeutic use; D065095:Calcineurin Inhibitors; D002170:Canada; D019317:Evidence-Based Medicine; D006801:Humans; D017410:Practice Guidelines as Topic; D011565:Psoriasis / Q000188:drug therapy*; D012176:Retinoids / Q000008:administration & dosage* / Q000627:therapeutic use; D014807:Vitamin D / Q000008:administration & dosage* / Q000627:therapeutic use
D000305:Adrenal Cortex Hormones; D065095:Calcineurin Inhibitors; D012176:Retinoids; D014807:Vitamin D