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Topical Non-steroidal Therapies

Del Rosso-Armstrong-Lebwohl-Brownstone

Quick Reference Chart

This table is not intended to replace medical judgment.

Generic Name
Brand Name/Vehicles
Dosage
Strength and FDA-Approved Ages
Max Dose as per PI
MOA
Clinical Considerations
PSORIASIS

Tapinarof

Vtama® (Cream)

QD

1% (≥18 yrs of age)

Does not specify

Aryl hydrocarbon
receptor agonist
(multiple mechanisms)

May be used on any skin site, for any severity of disease; no limitation on duration of use; no warnings or precautions in package insert.

Roflumilast

Zoryve® (Cream)

QD

0.3% (≥6 yrs of age)

Does not specify

PDE-4 inhibitor
(reduction in multiple
pro-inflammatory
cytokines)

May be used on any skin site, for any severity of disease; no limitation on duration of use; no warnings or precautions in package insert**; PI specifically mentions indication for
intertriginous areas. The 0.3% foam formulation is FDA approved for the treatment of seborrheic dermatitis in adult and pediatric patients 9 years of age and older.

Calcipotriene

Dovonex® (Ointment,
Cream), Sorilux®
(Foam)

QD to BID

0.005% Sorilux® (≥4 yrs of age) Dovonex® (≥18 yrs age)

<100g per week

Vitamin D analogue;
Anti-inflammatory,
Anti-proliferative

Used as monotherapy or adjunctively with topical corticosteroids for steroid-sparing effects. Use with caution with prolonged and widespread use in patients with significant hypercalcemia.

Tazarotene

Tazorac® (Gel, Cream)

QD

0.05%, 0.1% (≥18 yrs of age)

Does not specify

Retinoid;
Anti-inflammatory,
Anti-proliferative

May be used as monotherapy or adjunctively with topical corticosteroids for steroid-sparing effects; gel vehicle with greater risk of skin irritation especially with monotherapy; contraindicated in pregnancy; causes photosensitivity.

Calcipotriene and Betamethasone Dipropionate

Enstilar® (Foam),
Taclonex® (Ointment,
Suspension), Wynzora®
(Cream)*

QD

0.005/0.064% Enstilar® (≥12 yrs of age) Wynzora® (≥18 yrs of age) Taclonex® (≥12 yrs of age)

<60 g q4 days (Enstilar®) <100 g per week in adults <60 g per week in 12-17 yr old patients (Taclonex®/Wynzora®)

Vitamin D analogue &
corticosteroid combo;
Anti-inflammatory,
Anti-proliferative

Usual warnings with topical corticosteroids/ Vitamin D Analogues regarding sites of application, potential local adverse effects, prolonged durations of use, and potential systemic adverse effects apply

Halobetasol Propionate and Tazarotene

Duobrii® (Lotion)

QD

0.01%/0.045% (≥18 yrs of age)

<50 g per week

Retinoid & corticosteroid combo;
Anti-inflammatory,
Anti-proliferative

Formulation allows for lower concentrations of active ingredients without sacrificing efficacy; Usual warnings with topical corticosteroids/retinoids regarding sites of application, potential local adverse effects, prolonged durations of use, and potential systemic adverse effects apply.

ATOPIC DERMATITIS

Roflumilast

Zoryve® (Cream)

QD

0.15% (≥6 yrs of age)

Does not specify

PDE-4 inhibitor (reduction in multiple pro-inflammatory cytokines)

May be used on any skin site for mild to moderate atopic dermatitis; no limitation on duration of use; no warnings or precautions in package insert**; the 0.3% foam formulation is FDA approved for the treatment of seborrheic dermatitis in adult and pediatric patients 9 years of age and older

Ruxolitinib

Opzelura®†
(Cream)

BID

1.5% (≥12 yrs of age)

<60 g per week or
<100 g per 2 weeks;
<20% BSA

JAK 1/2 inhibitor

Efficacy comparable or better than topical triamcinolone in phase 2 study; Rapid and marked reductions in pruritus within hours to days; May be used on any anatomic skin site; boxed warnings noted in label.

Crisaborole

Eucrisa® (Ointment)

BID (can be reduced to QD once control achieved)

2% (≥3 months old)

Does not specify

PDE-4 inhibitor

Continued use limited in some patients by stinging and burning at sites of application (more often observed in real-world than noted in pivotal trials with AD).

Pimecrolimus, Tacrolimus

Elidel® (Cream),
Protopic® (Ointment)

QD to BID

1% cream (≥2 yrs of age),
0.03% and 0.01% ointment (Adults),
0.03% ointment (Children 2-15 yrs of
age)

Does not specify

Calcineurin inhibitor (inhibition of inflammatory cascade)

May be used on any affected anatomic site; some cases limited by local skin irritation; boxed warnings in package insert for malignancy (both agents); approvals designated for second line topical use.

* Only formulation available as a cream (oil-in-water formulation). Only cream formulation has pruritus reduction included as an outcome parameter in package insert. 

** Contraindicated in patients with severe hepatic insufficiency (based on oral formulation prescribing information) 

† Boxed warnings listed in package insert; PK, maximum use, and clinical study data support negligible risk if used in <20% BSA. Also approved for use in vitiligo with some differences in recommended use (see package insert for details).

DISCLAIMER: The dosages and other information seen in this chart were primarily obtained from the respective FDA-approved package inserts. This chart is for reference only and not to be substituted for clinical judgment. The authors are not responsible for treatment decisions or outcomes based on the information in this chart. Calcitriol ointment, anthralin, and tar not included in chart due to very limited use in clinical practice and other practical considerations. 

v2.1 - Jan. 8, 2024. © 2024 - April W. Armstrong, MD, MPH, James Q. Del Rosso, DO, Mark Lebwohl, MD, and Nicholas Brownstone, MD. This sheet is available for download at dermsquared.com/resources/nonsteroidal-topicals-chart

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