Table 3. Advantages, limitations, and practical considerations of the most commonly used topical formulations for psoriasis
Vehicle formulationAdvantagesLimitationsTypical use
OintmentOcclusive effect, potentially improves penetration and efficacy.26 Hydrating effect.Simple formula, often preservative-free.Greasiness as no evaporation or absorption.27Can be time-consuming and less cosmetically appealing.28Dry, thick, scaly plaques for body.Not for hair-bearing skin.
CreamLess greasy, more spreadable than ointment.27Some hydrating effect.Cosmetically acceptable.Less occlusive effect, decreased penetration and efficacy compared with ointment.All body areas.Hair-bearing areas including scalp with correct application technique.
Gel; water- or lipid-basedEasy application, easy to spread.27Cosmetically acceptable.Minimal or no occlusion.Minimal hydration.All body areas, especially well-suited for hair-bearing skin.
Aerosol foam; hydroalcoholic or emollient-basedEasy application, easy to spread.Usually no preservatives.Some skin hydration if emollient-based.29Cosmetically acceptable.Minimal occlusion and hydrating effects (hydroalcoholic).Some greasiness if emollient-based foam.Risk of stinging, irritation, and dryness if alcohol-based.29All body areas, especially hair-bearing areas (if not emollient-based).
LotionEasy application, not greasy.Cosmetically acceptable.Cooling skin effect.27No occlusive effect.No or minimal hydration.Hair-bearing areas.Not optimal for the treatment of thick, scaly plaques in other areas.
Solution; alcohol- or water-basedEasy to spread.Not greasy.No residue.Cosmetically acceptable.Stinging, irritation, and dryness if alcohol-based.Needs to be shaken (inhomogeneous solution).Hair-bearing areas.Avoid alcoholic solutions if they crack or excoriate skin.
ShampooDeveloped for scalp use.Not greasy.Cosmetically acceptable.No occlusive or hydrating effect.Complex application procedure.Short contact time with skin.Hair-bearing areas, especially scalp with dense hair growth.
  • Individual patient preferences, drug characteristics, and active pharmaceutical ingredient (API)-specific features have not been taken into account.