Topical Nonsteroidal and Fixed Combination Therapies for PsO and AD
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 | 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 | 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 yrs of age, and for plaque psoriasis of the scalp and body in adult and pediatric patients ≥12 yrs of age. |
Calcipotriene | Dovonex (Ointment, | QD to BID | 0.005% Sorilux (≥4 yrs of age) Dovonex (≥18 yrs age) | <100 g per week | Vitamin D analogue; | 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; | 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), | QD | 0.005/0.064% | <60 g q4 days (Enstilar) <100 g per week in adults <60 g per week in 12-17 yrs of age (Taclonex/Wynzora) | Vitamin D analogue & | Usual warnings with topical corticosteroids 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; | 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 | ||||||
Tapinarof | Vtama (Cream) | QD | 1% (≥2 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 | 0.05% (2-5 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 yrs of age. |
Ruxolitinib | Opzelura | BID | 1.5% (≥2 yrs of age) | <60 g per week or <100 g per 2 weeks ages 12 and older; | JAK 1/2 inhibitor | May be used on any skin site; efficacy comparable or better than topical triamcinolone in phase 2 study; rapid and marked reductions in pruritus within hours to days; also approved for use in vitiligo with some differences in recommended use (see package insert for details). |
Difamilast | Adquey (Ointment) | BID | 1% (≥2 yrs of age) | Does not specify | PDE-4 inhibitor | May be used on any skin site; no limitation on duration of use; no contraindications; no warnings or precautions in package insert. |
Crisaborole | Eucrisa (Ointment) | BID (can be reduced to QD once control achieved) | 2% (≥3 months of age) | 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 atopic dermatitis). |
Pimecrolimus, Tacrolimus | Elidel (Cream),† | QD to BID | 1% cream (≥2 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
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.
v8 - March 2026. © 2026 - April W. Armstrong, MD, MPH, James Q. Del Rosso, DO, Mark Lebwohl, MD, and Nicholas Brownstone, MD.