This handout is for plaque psoriasis (dermatology lens). Your care team identified this based on: sharply demarcated salmon-pink plaques with adherent silvery scale on extensor surfaces / scalp / gluteal cleft (aad-npf 2020 topicals + severity measures pmid 32738429).
Other reasons your team may use this plan: nail pitting / onycholysis / oil-drop / subungual hyperkeratosis — a strong psoriasis pivot and psa risk marker (aad-npf 2019 comorbidities pmid 30772097); chronic relapsing plaque disease with family history of psoriasis — treat-to-target chronic-care entry (aad-npf 2019 biologics pmid 30772098); inflammatory joint pain / dactylitis / enthesitis / inflammatory back pain with psoriasis → psoriatic-arthritis screen (aad-npf 2019 comorbidities pmid 30772097).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| triamcinolone acetonide | 0.1% cream/ointment | topical | BID to plaques; taper to weekend/proactive | AAD-NPF 2020 topicals (PMID 32738429) — potency matched to site/thickness; cornerstone of mild–moderate disease; rotate/combine with vitamin-D analog to limit atrophy and tachyphylaxis. |
| clobetasol propionate | 0.05% ointment/foam/solution | topical | BID short burst (≤2-4 wk) | AAD-NPF 2020 topicals (PMID 32738429) — superpotent burst for thick/scalp/palmoplantar plaques, then step down to mid-potency + vitamin-D analog maintenance. |
| calcipotriene | 0.005% cream/ointment/solution | topical | BID (max ~100 g/wk) | AAD-NPF 2020 topicals (PMID 32738429) — steroid-sparing maintenance; synergistic with TCS; weekend TCS + weekday vitamin-D analog reduces relapse and atrophy. |
| calcipotriene / betamethasone dipropionate | fixed-combination foam/gel/ointment | topical | once daily | AAD-NPF 2020 topicals (PMID 32738429) — fixed-dose combination is more effective than either component and improves adherence; preferred once-daily initial regimen for many plaques incl. scalp. |
| tazarotene | 0.05–0.1% cream/foam | topical | once daily nightly | AAD-NPF 2020 topicals (PMID 32738429) — normalises keratinocyte differentiation; combine with TCS to reduce irritation and boost efficacy; teratogenic (avoid in pregnancy). |
| tacrolimus | 0.1% ointment | topical | BID | AAD-NPF 2020 topicals (PMID 32738429) — off-label steroid-sparing for face/folds/genital/inverse psoriasis where TCS atrophy is a concern; transient burning. |
| tapinarof | 1% cream | topical | once daily | Non-steroidal AhR-modulating agent (post-guideline FDA-approved); steroid-free option with durable remittive effect; folliculitis/contact dermatitis class effects. |
| roflumilast | 0.3% cream | topical | once daily | Non-steroidal topical PDE4 inhibitor (post-guideline FDA-approved); well tolerated on intertriginous/inverse and facial sites; once-daily. |
| coal tar | 1–5% preparation/shampoo | topical | daily–several times weekly | AAD-NPF 2020 topicals (PMID 32738429) — long-established adjunct, scalp disease, and as a phototherapy adjunct (Goeckerman); cosmetic acceptability limits use. |
Plan: Plaque psoriasis — stepwise treat-to-target ladder (AAD-NPF 2019/2020)
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
Chronic-disease maintenance: treat-to-target reassessment q6 mo, proactive topical maintenance to recurrence-prone sites, lifelong PsA surveillance (early referral prevents irreversible joint damage), cardiometabolic / metabolic-syndrome / MASLD / IBD / depression screening and risk-factor modification (smoking, alcohol, weight — AAD-NPF 2019 comorbidities), trigger counselling (avoid systemic-steroid pulse — rebound/pustular flare risk), and step-down/step-up criteria. Dermatology continuity for any systemic agent; reassess CTCL if course remains atypical.
Guideline: Joint AAD-NPF Guidelines of care for psoriasis: biologics (Menter et al, JAAD 2019; PMID 30772098) + awareness/attention to comorbidities (Elmets et al, JAAD 2019; PMID 30772097) + topical therapy & severity measures (Elmets et al, JAAD 2020; PMID 32738429) + phototherapy (Elmets et al, JAAD 2019; PMID 31351884) + systemic nonbiologic therapies (Menter et al, JAAD 2020; PMID 32119894) + pediatric psoriasis (Menter et al, JAAD 2019; PMID 31703821); landmark trials VOYAGE 1 guselkumab (Blauvelt JAAD 2017; PMID 28057360), UltIMMa-1/2 risankizumab (Gordon Lancet 2018; PMID 30097359), POETYK PSO-1 deucravacitinib (Armstrong JAAD 2022; PMID 35820547), UNCOVER-2/3 ixekizumab (Blauvelt Am J Clin Dermatol 2017; PMID 28074446)