Local treatments of psoriasis and atopic dermatitis: from pharmacological targets to meta-analyses

Background Atopic dermatitis (AD) and psoriasis are common chronic inflammatory skin diseases associated with a substantial impact on quality of life. Topical therapies remain the cornerstone of treatment, particularly in patients with mild-to-moderate disease and in children. The therapeutic has progressively expanded from conventional topical corticosteroids and vitamin D analogues to targeted non-steroidal agents, including phosphodiesterase-4, aryl hydrocarbon receptor, and Janus kinase inhibitors. However, treatment effectiveness depends not only on the active molecule but also on formulation, treatment regimen, adherence, and patient preferences. Objectives To provide an overview of current topical treatments for AD and psoriasis, with a focus on their comparative efficacy and safety, the place of newer mechanism-driven therapies, and the specific considerations associated with their use in children. Main content Topical corticosteroids remain highly effective treatments for both AD and psoriasis. In AD, recent network meta-analysis data indicate that potent topical corticosteroids, tacrolimus 0.1%, and topical JAK inhibitors are among the most effective options across several clinical outcomes, whereas PDE4 inhibitors generally show lower efficacy. In psoriasis, historical evidence supports potent corticosteroids, particularly when combined with vitamin D analogues, while recent phase 3 trials have established roflumilast and tapinarof as effective non-steroidal options. Evidence for topical JAK inhibitors in psoriasis remains more limited. Treatment adherence is a major determinant of real-world effectiveness and is influenced by vehicle, treatment burden, education, and cosmetic acceptability. In children, topical therapy is particularly important, but comparative evidence remains limited and largely extrapolated from adult studies. Age-dependent pharmacokinetics, potential systemic absorption, local adverse effects, and specific safety concerns must therefore be considered when selecting and prescribing topical treatments. Future research should incorporate formulation characteristics, adherence, patient preferences, long-term safety, and standardized outcome measures to improve the clinical relevance of comparative evidence.