Topical
corticosteroids are the most common treatment agent for
psoriasis in the United States (U.S.). Conventional dermatologic wisdom holds that
ointment preparations provide the highest potency (due to their occlusive nature and moisturizing ability) and are best suited for
psoriasis. This article presents evidence challenging the conventional belief that
ointment vehicles are necessarily best for
psoriasis. A previous systematic review of the efficacy of clinical trials of potent topical
corticosteroids did not support greater efficacy or greater delivery of potent topical
corticosteroids with
ointment vehicles compared to other topical preparations. Moreover, preference studies demonstrate that
psoriasis patients often find application of
ointment to be messy, raising concerns about both short-term and long-term adherence to treatment. Recent compliance studies demonstrate that poor compliance to topical treatment is common among
psoriasis patients and contributes to poor
psoriasis treatment outcomes. Non-
ointment topical
corticosteroid products exhibit excellent efficacy in clinical practice. Much of the poor outcomes in
psoriasis, even tachyphylaxis, likely relate less to actual medication failure and more to failure to apply the medication. Topical
psoriasis treatment is likely to be more successful when physicians and patients discuss what type of vehicle the patient will use and plan treatment accordingly.