ABSTRACT
This chapter focuses on the concept of sequential therapy using topical agents. It describes the most common topical sequential therapy scheme in practice and illustrates the principles that guide the clinicians in choosing among existing schemes as well as creating new schemes. The most commonly practiced topical sequential therapy scheme for psoriasis in the United States involves halobetasol propionate ointment, a superpotent topical corticosteroid, and calcipotriene ointment, a vitamin D analog. The sequential use of calcipotriene and halobetasol propionate as described previously provides a solution to many of the aforementioned concerns. The activity of psoriatic lesions is often unpredictable and therapeutic goals range from maintenance of long-term remission, control of acute flares, or even a period of treatment cessation if the severity of psoriasis decreases. One of the new, innovative formulations of topical steroids uses a foam vehicle to deliver medication. Foam formulation is thermolabile and breaks down on contact with human skin and at body temperature.
