Topicals, Phototherapy, and Steroid Stewardship: Psoriasis Treatment Gets Personal

At the Masterclasses in Dermatology APP Institute, Cynthia Trickett, MPAS, PA-C, delivered a practical and patient-focused session titled “Psoriasis: Update in Topicals and Phototherapy.” From novel steroid-sparing agents to home-based phototherapy, Trickett offered an efficient guide for tailoring treatment to modern patients.

“Topical therapy as monotherapy is best for limited disease/special sites,” Trickett reminded attendees, but added that “topicals can be used in combination with phototherapy or systemics in more severe disease.”

Trickett opened with a refresher on topical corticosteroids, emphasizing formulation, location, and duration as key considerations and encouraging providers to practice “steroid stewardship” by integrating nonsteroidal agents whenever possible.

She highlighted tapinarof, a topical aryl hydrocarbon receptor agonist that suppresses Th17 pathways and improves skin barrier function. In trials, up to 40% of patients achieved clear or almost clear skin by week 12, with statistically significant itch relief as early as day 2.

Also spotlighted: roflumilast, a topical phosphodiesterase-4 inhibitor available in cream and foam formulations. “Monotherapy showed up to 63% of scalp patients achieving Investigator’s Global Assessment success by week 8,” Trickett noted, with strong results in intertriginous areas too.

Phototherapy got a well-deserved moment in the spotlight. Trickett reviewed the mechanisms and practical use of narrowband UVB (NB-UVB)—still considered safe, effective, and non-immunosuppressive.

“Patients may clear in 24 to 36 treatments,” she said, adding that home NB-UVB units can improve access for select candidates.

She also covered excimer laser, ideal for spot treatment, and psoralen ultraviolet A therapy, which “has a higher skin cancer risk and is not used as frequently” today. For patients with significant comorbidities or who are not biologic candidates, Trickett revisited Goeckerman therapy, a time-intensive but effective blend of coal tar and light still used in select centers.

Topicals remain a powerful first-line option, especially when used wisely. And phototherapy, although sometimes underutilized, still has a vital role for patients with broader disease.

“Understanding various potencies and vehicles promotes adherence and reduces steroid-related adverse events,” Trickett emphasized. “Phototherapy is a very effective and safe steroid-sparing option for moderate-to-severe disease.”

Reference

Trickett C. Psoriasis: Update in topicals and phototherapy. Presented at: Masterclasses in Dermatology APP Institute; October 11–12, 2025; Dallas, TX.