Table 3. Advantages, limitations, and practical considerations of the most commonly used topical formulations for psoriasis.
| Vehicle formulation | Advantages | Limitations | Typical use |
|---|---|---|---|
| Ointment | Occlusive 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.28 | Dry, thick, scaly plaques for body.Not for hair-bearing skin. |
| Cream | Less 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-based | Easy 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-based | Easy 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.29 | All body areas, especially hair-bearing areas (if not emollient-based). |
| Lotion | Easy application, not greasy.Cosmetically acceptable.Cooling skin effect.27 | No 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-based | Easy 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. |
| Shampoo | Developed 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.