Evolving Options in Psoriasis: A Closer Look at Nonsteroidal Topicals

EP: 1.Challenges With Topical Psoriasis Treatments and the Need for Simpler Options

EP: 2.Why Treating Scalp Psoriasis With Topicals Remains a Challenge

EP: 3.The Utility of Topical Treatment in Skin of Color

EP: 4.Designing the Ideal Topical: Relieving Itch and Improving Quality of Life

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EP: 5.Evolving Options in Psoriasis: A Closer Look at Nonsteroidal Topicals

The conversation wrapped up with a focus on how recent innovations—specifically topical tapinarof and roflumilast—are reshaping the treatment landscape for plaque psoriasis. Both experts emphasized that these new agents address long-standing gaps in psoriasis care. Notably, these nonsteroidal options show efficacy that can rival topical corticosteroids when used over longer durations (8 to 12 weeks), and they come without the drawbacks of steroids, such as long-term safety concerns or lack of suitability for maintenance therapy. With better tolerability and safety profiles, these medications present a viable option for chronic management.

From a mechanistic standpoint, the doctors highlighted the scientific appeal of these drugs. Tapinarof works via the aryl hydrocarbon receptor pathway, helping to regulate immune function and restore homeostasis, whereas roflumilast is a next-generation PDE4 inhibitor, improving on older PDE4 agents with greater potency and tolerability. These mechanisms represent a shift from simply suppressing inflammation with steroids to more targeted, durable modulation of immune pathways. Importantly, both medications have shown either continued improvement post treatment (as seen with tapinarof) or sustained efficacy with intermittent use (as in long-term roflumilast studies), which makes them appealing for managing a lifelong condition like psoriasis.

However, a key limitation remains: scalp involvement. Although these creams can be used in sensitive or intertriginous areas where steroids or Topical calcineurin inhibitors often fail due to irritation or absorption concerns, their cream formulations are less practical for patients with diffuse scalp disease. The experts pointed out that applying a cream through dense or styled hair is cumbersome, especially for women or individuals with Afro-textured hair. This highlights an ongoing unmet need—to adapt these novel, nonsteroidal mechanisms into scalp-friendly vehicles, such as foams or solutions, to ensure broader utility and patient adherence in real-world settings.