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 | 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 |
Calcipotriene | Dovonex® (Ointment, | QD to BID | 0.005% Sorilux® (≥4 yrs of age) Dovonex® (≥18 yrs age) | <100g 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% 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 & | 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; | 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®† | BID | 1.5% (≥12 yrs of age) | <60 g per week or | 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), | 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; 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