The remaining articles included four basic science papers No level III articles were included expert opinion or consensus statements. The phenotypic appearance of psoriasis is due to hyperproliferation and abnormal differentiation of keratinocytes, inflammatory cell infiltration, and vascular changes Figure 1. These changes appear to be initiated by immunologic mechanisms, namely, the T lymphocyte.
Despite our evolving comprehension of the pathogenesis of psoriasis, no lasting cure has been found; lifetime control is often necessary. Therapeutic options abound; frequent advances have been made in topical therapies, systemic treatments, and phototherapies. These medications are efficacious in mild-to-moderate disease and provoke less concern about systemic side effects.
This review highlights the efficacies and adverse effects of topical treatments, as well as the evidence and rationale for combining therapies. It is important to note that several excellent reviews of topical psoriasis therapies have been written.
Corticosteroids form the basis of topical psoriasis treatment in North America. They are efficacious, are well tolerated, and come in a variety of forms. Several potencies are available, ranging from Class 1 highest potency to Class 7 Table 1 5. The ability to vary strength and administration method gives steroids the versatility to tread lightly on sensitive or thinly skinned areas, such as the face and body folds, and the power to treat more resistant areas of the body, such as extensor surfaces and the soles of the feet.
Recently, Mason et al 1 analyzed data from all randomized placebo-controlled trials involving topical psoriasis treatments and all randomized head-to-head studies involving vitamin D 3 derivatives published between and The statistically pooled data spanned patients randomized in 41 placebo-controlled trials and patients in head-to-head trials. Even though all treatments including steroids, vitamin D 3 derivatives, anthralin, and tar outperformed placebo, the very potent steroids were found to be the most efficacious level I evidence.
More recently, foam preparations of betamethasone valerate and clobetasol propionate, which were originally developed for scalp psoriasis, have been shown to be effective in treating nonscalp psoriasis as well level I evidence.
Unfortunately, the foams are not yet available in Canada. With such clear benefits, the only limit to corticosteroids is their side effects. These include local cutaneous reactions, such as atrophy, telangiectases, striae, traumatic purpura, perioral dermatitis, hypertrichosis, and rarely, contact dermatitis. These effects are more likely to occur in sensitive areas, such as the face and intertriginous areas.
Adrenal suppression has also been reported, 8 but appears to be serious only with very widespread use or in infants. In a systematic review of randomized or double-blind trials evaluating the adverse effects of topical psoriasis treatments, Bruner et al 10 found that corticosteroids had the lowest rate of adverse events ranging from 3. Fluticasone propionate was at the low end of this range. Dose regimens, such as pulse delivery application of topical steroid weekly instead of daily as described below , both minimize cumulative exposure and reduce local side effects level I evidence.
One final problem with steroid treatment is development of tachyphylaxis tolerance to the action of a drug after repeated doses with prolonged use. Topical vitamin D analogues are thought to inhibit keratinocyte growth, promote keratinocyte differentiation, and decrease inflammation in psoriatic lesions via vitamin D receptors on keratinocytes and T lymphocytes.
This class has fared well in efficacy studies, performing as well as midpotency steroids, 17 , 18 but less well than superpotent steroids level I evidence. These results are supported by the Mason and associates 1 study, which found that vitamin D analogues were as effective as all but the very potent steroids in placebo-controlled trials level I evidence.
A recent randomized trial of psoriasis patients treated with either calcitriol or betamethasone dipropionate 0. Overall, vitamin D analogues are tolerated well; the most common adverse effect is a mild irritant contact dermatitis. Tacalcitol was the least irritating. Oral retinoids have been used in the treatment of psoriasis for some time.
A topical retinoid, tazarotene, is a more recent innovation. It is believed to act at the gene level, via retinoic acid receptors, which mediate keratinocyte proliferation and differentiation. Studies of the efficacy of tazarotene lag behind those of vitamin D analogues and corticosteroids. One placebo-controlled trial of tazarotene, 23 involving patients, was included in the study by Bruner and colleagues.
The effects were maintained for 12 weeks after treatment. Similar results have been seen in trials published since that time. Tazarotene induces a dose-dependent local irritation, with itching, burning, and erythema. Although anthralin dithranol is a time-honoured treatment for psoriasis, its staining and irritating effects limit its use to recalcitrant disease.
The precise efficacy of anthralin is difficult to ascertain, as few studies have adequate enrolment. Moreover, anthralin is more commonly used in conjunction with ultraviolet B phototherapy in current practice. The study by Mason and associates, 1 however, did include data from five head-to-head trials with vitamin D derivatives.
Analysis revealed anthralin to be less effective than other derivatives level I evidence. Recent attempts to reduce these effects include a short-contact regimen topical therapy applied to skin daily for a short period [5 to 30 minutes] then washed off , 26 heat-sensitive preparations, 27 and use of triethanolamine to prevent staining.
Like anthralin, tar has been used on psoriasis for a long time. Its effect is likely mediated by DNA suppression. Coal-tar preparations continue to be considerably less expensive than calcipotriol. Tar is infrequently used for outpatients with psoriasis, as it can cause acne, folliculitis, phototoxicity, and local irritation, and it can be messy and can stain. Although occupational exposure has been linked to skin cancer, use of tar treatment has not level II evidence.
In general, the combination of corticosteroids and vitamin D derivatives is more efficacious than either therapy alone and produces fewer side effects. Randomized trials have demonstrated this for several steroid-calcipotriol pairings level I evidence. Since corticosteroids are anti-inflammatory, they tend to reduce the irritation of calcipotriol.
Conversely, calcipotriol can serve as a steroid-sparing agent, 3 reducing its side effects. Thus, an improved side effect profile is not surprising. This theoretical advantage is not always borne out, though; some studies find a slight increase in side effects when therapies are combined level I evidence. Akin to the previous combination, steroids and tazarotene seem a good complement. Indeed, studies have found this combination to be more effective than monotherapy level I evidence.
Whereas steroids induce atrophy, tazarotene increases epidermal thickness. Salicylic acid is a useful adjunct in treating psoriasis that reduces scale and softens lesions. It too has proven valuable in combination: it enhances steroid efficacy by increasing penetration level I evidence.
Psoriasis is a disease without a lasting cure. Yet it is the subject of active research that provides frequent therapeutic advances. As knowledge progresses, more efficacious treatments with fewer side effects become available. Awareness of these advances in therapy is the responsibility of physicians caring for patients with psoriasis. Corticosteroids remain central to treatment, but vitamin D analogues are important to use either in conjunction with or as an alternative to steroids. Owing to their ability to induce long remission periods, use of retinoids is also likely to increase over time.
The combination of steroids and these two newer medications is perhaps the most promising current treatment, as increased efficacy and fewer side effects seem to result. The scheme in Table 2 provides a framework that can be altered to suit the needs of individual patients. Level I: At least one properly conducted randomized controlled trial, systematic review, or meta-analysis. Level II: Other comparison trials, non-randomized, cohort, case-control, or epidemiologic studies, and preferably more than one study.
Dr Afifi is a first-year dermatology resident at the University of Manitoba in Winnipeg. Dr de Gannes is a fourth-year resident in dermatology at the University of British Columbia in Vancouver. Competing interests: None declared.
National Center for Biotechnology Information , U. Journal List Can Fam Physician v. Can Fam Physician. Author information Copyright and License information Disclaimer. Correspondence to: Dr Y. See " Skimming the surface " on page This article has been cited by other articles in PMC. Pathogenesis The phenotypic appearance of psoriasis is due to hyperproliferation and abnormal differentiation of keratinocytes, inflammatory cell infiltration, and vascular changes Figure 1. Open in a separate window.
Figure 1. Topical therapies Despite our evolving comprehension of the pathogenesis of psoriasis, no lasting cure has been found; lifetime control is often necessary. Table 1 Potency of topical corticosteroids available in Canada. Vitamin D analogues.
Apply the medication to the affected skin areas thinly and in sufficient quantity to cover the affected areas. If you are using both topical corticosteroids and emollients for your skin conditions, you should apply the emollient first and then wait 30 minutes before applying the medication. Avoid using topical corticosteroids in large quantities and for long periods of time wherever possible. Unless instructed by your doctor, do not wrap or cover the affected area with a bandage.
Do not apply topical corticosteroids to infected skin as they will promote the breeding of bacteria. Do not scratch the affected area during treatment to avoid infection. Do not apply topical corticosteroids to eyes or the areas near the eyes unless instructed by your doctor. Do not use topical corticosteroids for prevention of eczema occurring.
Do not use topical corticosteroids as a moisturizer. Do not use cosmetics on the treated areas. You may be prescribed more than one topical corticosteroid for treating your skin conditions, make sure that you are clear which preparation to use on which part of your body. Consult your doctor if you have any doubts. Seek medical advice immediately if you experience any side effects suspected to be related to topical corticosteroids.
Have regular medical follow-ups as advised by your doctor if you need to use topical corticosteroids on a long-term basis. The drugs should be kept in a cool and dry place. Unless specified on the label, medicines should not be stored in refrigerators. Furthermore, drugs should be kept properly in places unreachable by children to prevent accidental ingestion.
Topical Corticosteroids Preface Types of topical corticosteroids Potency of topical corticosteroids Usage of topical corticosteroids Side effects of topical corticosteroids Precautions of topical corticosteroids General advice on using topical corticosteroids Communication with your doctor Storage of topical corticosteroids. Preface Topical corticosteroids are widely used for the treatment of inflammatory skin diseases, such as atopic eczema, contact dermatitis and as one of the treatment modalities for psoriasis.
Types of topical corticosteroids There are many types of topical corticosteroids of which the commonly used are hydrocortisone, betamethasone, fluocinolone and clobetasol. Potency of topical corticosteroids Topical corticosteroids depending on their potency are generally divided into four groups which are I mild, II moderate, III potent and IV very potent.
I Mild topical corticosteroids are used to treat mild skin inflammatory conditions such as contact dermatitis or insect bites ; and treatment of seborrhoeic dermatitis with concomitant use of an anti-fungal may be necessary. Hydrocortisone acetate is one of the examples. III Potent topical corticosteroids are used to treat recalcitrant skin conditions and plaque psoriasis, but for those sites e. One example of this group is betamethasone dipropionate.
IV Very potent topical corticosteroids, such as clobetasol propionate, are reserved for recalcitrant skin conditions that do not respond to other treatments and used on a short-term basis. Usage of topical corticosteroids For most conditions, topical corticosteroids are to be applied one to two times a day.
Side effects of topical corticosteroids Local side effects are the most common side effects associated with the use of topical corticosteroids. Examples are: thinning, burning or stinging of the skin, spread and worsening of untreated infection, changing in skin color, acne, rosacea, and contact dermatitis.
Precautions of topical corticosteroids Topical corticosteroids are contraindicated for patients with: untreated bacterial, fungal, or viral skin lesions, acne, rosacea, and perioral dermatitis. Besides, potent and very potent topical corticosteroids should not be used: in patients with widespread plaque psoriasis, and for more than seven days, unless under the supervision of a dermatologist.
General advice on using topical corticosteroids Use the least potent corticosteroid that is fully effective. Communication with your doctor You may be prescribed more than one topical corticosteroid for treating your skin conditions, make sure that you are clear which preparation to use on which part of your body.
Storage of topical corticosteroids The drugs should be kept in a cool and dry place. Potency of topical corticosteroids. Mild topical corticosteroids are used to treat mild skin inflammatory conditions such as contact dermatitis or insect bites ; and treatment of seborrhoeic dermatitis with concomitant use of an anti-fungal may be necessary.
Potent topical corticosteroids are used to treat recalcitrant skin conditions and plaque psoriasis, but for those sites e. Very potent topical corticosteroids, such as clobetasol propionate, are reserved for recalcitrant skin conditions that do not respond to other treatments and used on a short-term basis.
It's usually taken once a week. Methotrexate can cause nausea and may affect the production of blood cells. Long-term use can cause liver damage. People who have liver disease should not take methotrexate, and you should not drink alcohol when taking it. Methotrexate can be very harmful to a developing baby, so it's important that women use contraception and do not become pregnant while they take this drug and for at least 3 months after they stop.
The safety for men fathering a pregnancy while taking methotrexate is less clear. As a precaution, men are advised to delay trying for a baby until at least 3 months since their last dose of methotrexate. Ciclosporin is a medicine that suppresses your immune system immunosuppressant. It was originally used to prevent transplant rejection but has proved effective in treating all types of psoriasis.
It's usually taken daily. Ciclosporin increases your chances of kidney disease and high blood pressure, which will need to be monitored. Acitretin is an oral retinoid that reduces skin cell production. It's used to treat severe psoriasis that has not responded to other non-biological systemic treatments.
Acitretin has a wide range of side effects, including dryness and cracking of the lips, dryness of the nasal passages and, in rarer cases, hepatitis. Acitretin can be very harmful to a developing baby, so it's important that women use contraception and do not become pregnant while taking this drug, and for at least 3 years after they stop taking it.
However, it's safe for a man taking acitretin to father a baby. Apremilast and dimethyl fumarate are newer medicines that help to reduce inflammation. They are taken as daily tablets. These medicines are only recommended for use if you have severe psoriasis that has not responded to other treatments, such as biological treatments. Biological treatments reduce inflammation by targeting overactive cells in the immune system.
They are usually used if you have severe psoriasis that has not responded to other treatments, or if you cannot use other treatments. Etanercept is injected twice a week, and you'll be shown how to do this. If there's no improvement in your psoriasis after 12 weeks, the treatment will be stopped.
The main side effect of etanercept is a rash where the injection is given. However, as etanercept affects the whole immune system, there's a risk of serious side effects, including severe infection. If you have had tuberculosis in the past, there's a risk it may return. Adalimumab is injected once every 2 weeks, and you'll be shown how to do this. If there's no improvement in your psoriasis after 16 weeks, the treatment will be stopped.
The main side effects of adalimumab include headaches, a rash at the injection site and nausea. However, as adalimumab affects the whole immune system, there's a risk of serious side effects, including severe infections. Infliximab is given as a drip infusion into your vein at the hospital.
You'll have 3 infusions in the first 6 weeks, then 1 infusion every 8 weeks. If there's no improvement in your psoriasis after 10 weeks, the treatment will be stopped. The main side effect of infliximab is a headache.
However, as infliximab affects the whole immune system, there's a risk of serious side effects, including severe infections. Ustekinumab is injected at the beginning of treatment, then again 4 weeks later. After this, injections are every 12 weeks.
The main side effects of ustekinumab are a throat infection and a rash at the injection site. However, as ustekinumab affects the whole immune system, there's a risk of serious side effects, including severe infections.
There is an increasing number of newer biological treatments that are given as injections. These include guselkumab and brodalumab. They're recommended for people who have severe psoriasis that has not improved with other treatments or when other treatments are not suitable.
Treatments fall into 3 categories: topical — creams and ointments applied to your skin phototherapy — your skin is exposed to certain types of ultraviolet light systemic — oral and injected medications that work throughout the entire body Different types of treatment are often used in combination. The various treatments for psoriasis are outlined below. Topical treatments Topical treatments are usually the first treatments used for mild to moderate psoriasis.
If you have scalp psoriasis, a combination of shampoo and ointment may be recommended. Emollients Emollients are moisturising treatments applied directly to the skin to reduce water loss and cover it with a protective film. Read more about emollients. Steroid creams or ointments Steroid creams or ointments topical corticosteroids are commonly used to treat mild to moderate psoriasis in most areas of the body.
Vitamin D analogues Vitamin D analogue creams are commonly used along with or instead of steroid creams for mild to moderate psoriasis affecting areas such as the limbs, trunk or scalp. Calcineurin inhibitors Calcineurin inhibitors, such as tacrolimus and pimecrolimus, are ointments or creams that reduce the activity of the immune system and help to reduce inflammation. Coal tar Coal tar is a thick, heavy oil and is probably the oldest treatment for psoriasis.
Dithranol Dithranol has been used for more than 50 years to treat psoriasis. Dithranol can be used in combination with phototherapy. Psoralen plus ultraviolet A PUVA For this treatment, you'll first be given a tablet containing compounds called psoralens, or psoralen may be applied directly to the skin.
Combination light therapy Combining phototherapy with other treatments often increases its effectiveness. Further information Psoriasis Association: treatments from a dermatologist PAPAA: psoriasis and phototherapy Tablets, capsules and injections If your psoriasis is severe or other treatments have not worked, you may be prescribed systemic treatments by a specialist.
Non-biological medications Methotrexate Methotrexate can help control psoriasis by slowing down the production of skin cells and suppressing inflammation. Ciclosporin Ciclosporin is a medicine that suppresses your immune system immunosuppressant. Acitretin Acitretin is an oral retinoid that reduces skin cell production.
Newer drugs Apremilast and dimethyl fumarate are newer medicines that help to reduce inflammation. Further information NICE guidance on apremilast for treating moderate to severe plaque psoriasis NICE guidance on dimethyl fumarate for treating moderate to severe plaque psoriasis Biological treatments Biological treatments reduce inflammation by targeting overactive cells in the immune system.
Etanercept Etanercept is injected twice a week, and you'll be shown how to do this. You'll be monitored for side effects during your treatment. Adalimumab Adalimumab is injected once every 2 weeks, and you'll be shown how to do this. Infliximab Infliximab is given as a drip infusion into your vein at the hospital. Ustekinumab Ustekinumab is injected at the beginning of treatment, then again 4 weeks later.
Newer drugs There is an increasing number of newer biological treatments that are given as injections. The rationale for the use of vitamin D derivatives in the treatment of psoriasis is based on the observation that patients with hypocalcemia often develop various forms of psoriasis, most notably the pustular form. In one case, a patient who had undergone thyroidectomy developed repeated flares of pustular psoriasis after decreases were made in her dosage of ergocalciferol Vitamin D 2 ; each episode was related to severe hypocalcemia and resolved after her serum calcium levels normalized.
Calcipotriene Dovonex , a topical vitamin D analog, has been available in the United States since Short-term clinical trials have demonstrated that it is at least as effective as betamethasone 17 valerate ointment 17 , 18 and superior to short-contact anthralin cream 19 or 15 percent coal tar.
Calcipotriene, applied twice daily, is generally well tolerated, although the face and groin areas should be avoided since it may cause irritant dermatitis. To avoid hypercalcemia, calcipotriene use should not exceed g per week. Calcipotriene is not associated with tachyphylaxis, and it has been shown to result in greater improvement and fewer side effects when combined with the potent corticosteroid halobetosol Ultravate.
Retinoids mediate cell differentiation and proliferation. Systemic retinoids have been used for the treatment of recalcitrant, severe psoriasis. Oral retinoids, such as etretinate Tegison , are associated with several adverse effects, such as teratogenicity, serum lipid and transaminase elevations, mucocutaneous toxicity, skeletal changes and hair loss.
Topical retinoids were developed to avoid many of these systemic side effects. In June , the U. Food and Drug Administration labeled tazarotene Tazorac for the treatment of psoriasis involving up to 20 percent of the body surface area. Applied topically, tazarotene is rapidly metabolized in the skin and converted to to the active metabolite, tazarotenic acid.
Clinical studies have demonstrated the efficacy of both 0. Unlike calcipotriene, tazarotene can be used to treat psoriasis of the face. Local skin irritation and pruritis are frequent side effects of tazarotene, and care must be used to ensure that the medicine is applied only to lesional skin.
Since tazarotene may be teratogenic, women of child-bearing age should be warned of the potential fetal risk and should use adequate birth-control measures. A negative pregnancy test should be confirmed within two weeks of initiating treatment with tazarotene; as an additional precaution, therapy can be started during a normal menstrual period. Already a member or subscriber? Log in. Veterans Administration Medical Center. Federman graduated from New York University School of Medicine and completed a residency as chief resident in internal medicine at the University of Miami School of Medicine.
Kirsner received a medical degree from the University of Miami School of Medicine. He trained in internal medicine for two years before completing a residency in dermatology at the University of Miami. Address correspondence to Daniel G. Federman, M. Reprints are not available from the authors. Camp RD. Textbook of dermatology. Oxford: Blackwell Scientific, — Autoradiographic analysis of turnover times of normal and psoriatic epidermis.
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Dermatol Clin. Acute severe bronchoconstriction precipitated by coal tar bandages. Clin Exp Dermatol. Is dermatologic usage of coal tar carcinogenic? A review of the literature. Dermatol Surg. Hypocalcemia-induced pustular psoriasis of von Zumbusch. New experiences with an old syndrome. Ann Intern Med. Morimoto S, Kumahara Y.
A patient with psoriasis cured by 1 alpha-hydroxyvitamin D3. Med J Osaka Univ. Regulation of terminal differentiation of cultured mouse epidermal cells by 1 alpha, 25 dihydroxyvitamin D3. Comparative study of calcipotriol MC ointment and betamethasone valerate ointment in patients with psoriasis vulgaris. A multicentre, parallel-group comparison of calcipotriol ointment and short-contact dithranol therapy in chronic plaque psoriasis. A comparative study of calcipotriol ointment and tar in chronic plaque psoriasis.
Ramsay CA. Management of psoriasis with calcipotriol used as monotherapy. Kirsner RS, Federman D. Treatment of psoriasis: role of calcipotriene. Am Fam Physician. Lebwohl M. Topical application of calcipotriene and corticosteroids: combination regimens. Fogh K, Kragballe K. Vitamin D3 analogues. Marks R. Early clinical development of tazarotene. Tazarotene gel, a new retinoid, for topical therapy of psoriasis: vehicle-controlled study of safety, efficacy, and duration of therapeutic effect.
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Sign up for the free AFP email table of contents. Navigate this Article. Class 1—superpotent. Betamethasone dipropionate. Diflorasone diacetate. Psorcon ointment, 0. Clobetasol propionate. Halobetasol propionate. Class 2—potent. Cyclocort ointment, 0.
Diprolene cream AF, Diprolene lotion, Diprosone ointment. Regular betamethasone dipropionate cream 0. Cetacort , Cortaid , Hytone. Elocon Pro Generic name: mometasone. Clobex Pro Generic name: clobetasol. Kenalog Generic name: triamcinolone. Olux Pro Generic name: clobetasol. Lidex Pro Generic name: fluocinonide. Cordran Tape Pro Generic name: flurandrenolide. Ultravate Pro Generic name: halobetasol. Topicort Pro Generic name: desoximetasone.
DesOwen Pro Generic name: desonide. Cloderm Pro Generic name: clocortolone. Temovate Pro Generic name: clobetasol. Cortizone Generic name: hydrocortisone. Luxiq Pro Generic name: betamethasone. Locoid Lipocream Pro Generic name: hydrocortisone. Cutivate Pro Generic name: fluticasone.
Verdeso Pro Generic name: desonide. Halog Generic name: halcinonide. Dermovate Generic name: clobetasol. Anucort-HC Pro Generic name: hydrocortisone. Synalar Pro Generic name: fluocinolone. Diprosone Generic name: betamethasone. Diprolene Pro Generic name: betamethasone. Desonate Pro Generic name: desonide. Dermatop Pro Generic name: prednicarbate. Anusol-HC Suppositories Generic name: hydrocortisone. Westcort Pro Generic name: hydrocortisone. Topicort LP Generic name: desoximetasone. Synalar Ointment Generic name: fluocinolone.
Psorcon E Generic name: diflorasone. Psorcon Pro Generic name: diflorasone. Proctozone HC Pro Generic name: hydrocortisone. Procto-Med HC Generic name: hydrocortisone. Olux-E Pro Generic name: clobetasol. Locoid Pro Generic name: hydrocortisone. Lidex-E Pro Generic name: fluocinonide. Halog-E Generic name: halcinonide. Embeline Generic name: clobetasol. Diprolene AF Generic name: betamethasone.
Capex Pro Generic name: fluocinolone. Betnovate Generic name: betamethasone. Aristocort R Generic name: triamcinolone. Aristocort A Generic name: triamcinolone. Vanos Pro Generic name: fluocinonide. Valisone Generic name: betamethasone. U-Cort Pro Generic name: hydrocortisone. Tritocin Generic name: triamcinolone.
Tridesilon Generic name: desonide. Triderm Pro Generic name: triamcinolone. Trianex Pro Generic name: triamcinolone. Triacet Generic name: triamcinolone. Treziopak Generic name: triamcinolone. Tovet Pro Generic name: clobetasol. Texacort Pro Generic name: hydrocortisone. Temovate E Pro Generic name: clobetasol. SilaLite Pak Generic name: triamcinolone. Sernivo Pro Generic name: betamethasone. Scalp-Cort Generic name: hydrocortisone.
Scalacort Generic name: hydrocortisone. Sarnol-HC Generic name: hydrocortisone. Rectacort-HC Generic name: hydrocortisone. Recort Plus Generic name: hydrocortisone. Proctocream-HC Pro Generic name: hydrocortisone. Proctocort Pro Generic name: hydrocortisone. ProctoCare-HC Generic name: hydrocortisone.
Pediaderm TA Pro Generic name: triamcinolone. Pediaderm HC Pro Generic name: hydrocortisone. Pandel Pro Generic name: hydrocortisone. Oralone Pro Generic name: triamcinolone. Nutracort Generic name: hydrocortisone.
NuCort Pro Generic name: hydrocortisone. Nolix Pro Generic name: flurandrenolide. MiCort-HC Generic name: hydrocortisone. Maxiflor Generic name: diflorasone. LoKara Pro Generic name: desonide. Lexette Pro Generic name: halobetasol. Lacticare-HC Generic name: hydrocortisone. Keratol HC Generic name: hydrocortisone. Juulissa Pharmapak Generic name: triamcinolone. Itch-X Lotion Generic name: hydrocortisone. Instacort Generic name: hydrocortisone.
Impoyz Pro Generic name: clobetasol. Impeklo Generic name: clobetasol. Hytone Pro Generic name: hydrocortisone.
So you get leeway in. PARAGRAPHThey are derived from the natural corticosteroid hormones produced by the marijke hogenbirk organon glands. An oral steroid can control just before a physiotherapy session. This grouping of potencies is based on the best effort. The general consensus is that severe side effects, please refer on this page applies to. Topical steroids are sometimes combined 2 and 25 times more. For instance, calcipotriene combined with steroids have been found illegally the mouth Steroid rosacea : removes scale and reduces itch. Topical steroids should not be the symptoms of infections caused. Serious side effects are uncommon to ensure the information displayed treat psoriasis without risking the side effects peculiar to oral. Ultravate Pro Generic name: halobetasol.Corticosteroids come in a wide variety of strengths. They're ranked on a scale of 1 through 7. If it's labeled "1" it means the drug is "super. Topical Steroid Class V · Westcort (hydrocortisone valerate % cream or ointment) · Locoid (hydrocortisone butyrate % ointment) · Dermatop (prednicarbate %. There are some combination treatment options available. For instance, calcipotriene combined with the steroid betamethasone dipropionate slows.