Topical Therapy of Psoriasis

The goal of psoriasis treatment is to achieve control of the disease process and to decrease the area of body surface involvement. Finally, for the majority of cases complete clearance and the maintenance of long-term remission is a realistic expectation of psoriasis treatment. Topical treatment, sometimes in combination with UV phototherapy, is sufficient in most cases of mild and moderate psoriasis and only severe cases require systemic treatment. Nowadays our armamentarium of topical drugs includes keratolytics, anthralin (dithranol, cignolin), calcipotriene, topical corticosteroids, tazarotene, topical tar and some other less effective substances. The variety of topical therapy regimes and their different modes of action allow to combine different therapy modalities thus increasing efficacy and reducing side effects as compared to monotherapy. The combination should be selected in a way that a drug with predominant anti-inflammatory activities such as corticosteroids and/or UV-light is combined with a drug with anti-proliferative activities (calcipotriene, tazarotene). Despite our detailed knowledge on psoriasis pathogenesis and the role of different drugs good evidence-based guidelines on best current practice are still missing. Therefore, well established comparative therapy studies are urgently needed to provide the most effective care for the patient. The goal has to be the achievement and maintenance of long-term remission. In this respect, therapy with anthralin is since almost ninety years still the golden standard of psoriasis therapy. Therefore, all other topical treatments and therapy combinations have to be compared with anthralin under the aspects of socio-economy, effectiveness, long-term remission and life quality.