Are ointments better than other vehicles for corticosteroid treatment of psoriasis?

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.