Topicals for Psoriasis: Classical Drugs, New Concepts, and New Medications.

Abstract

Psoriasis is a chronic, immune-mediated disease affecting the skin. Its prevalence varies by region (0.2-9%), and some patients may develop joint involvement. For mild disease, and as adjuncts in moderate disease, topical therapies remain the foundation of care. Classical agents include topical corticosteroids and vitamin D analogs. Other legacy options (tazarotene, salicylic acid, coal tar, and calcineurin inhibitors) serve as adjuvants with variable efficacy. Recent advances have led to new targeted nonsteroidal topicals such as tapinarof (aryl hydrocarbon receptor agonist) and roflumilast (phosphodiesterase 4 inhibitor). We summarize evidence, propose practical prescribing recommendations for nondermatologists, and position new agents within a steroid-sparing, precision framework. A persistent challenge is affordability, in which high acquisition costs for novel topicals may restrict real-world access unless supported by pricing and reimbursement policies. This work was presented at the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) 2025 annual meeting in Bogotá as a concurrent session.