Major developments in topical therapy for psoriasis have taken place since 1500 B.C. Older methods such as coal tar and anthralin therapy are effective but less popular given difficulty of use. Topical steroids were a revolutionary development for psoriasis. However, they are limited in use due to local and systemic side effects. Non-steroidal topical agents are less efficacious than super-potent topical steroids but have a more favorable side effect profile. Combination medications, such as betamethasone/calcipotriene agents, allow the agents to act synergistically for psoriasis management, while maintaining a safe side effect profile. We recommend a sequential strategy when using a newer combination agent to maximize efficacy and safety, and increase patient compliance.
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