Which of the following would be recommended first-line to manage a psoriasis exacerbation?

• A. Betamethasone valerate 0.025% cream - Moderate potency
• B. Hydrocortisone acetate 1% cream - mild
• C. Clobetasone butyrate 0.05% cream - Moderate potency
• D. Clobetasol propionate 0.05% cream - Very potent

Answer: (B)

The main idea is choosing a topical corticosteroid with the right balance of anti-inflammatory effect and safety for a psoriasis flare. For a first-line approach to a psoriasis exacerbation, a mild-potency steroid is preferred because it can reduce inflammation and itch while minimizing risks such as skin thinning, stretch marks, and systemic absorption. Hydrocortisone acetate 1% cream provides anti-inflammatory relief without the higher risks associated with stronger steroids, making it safer for initial management, especially if the flare is mild or involves sensitive areas. If the flare isn’t adequately controlled after a short trial, you can consider stepping up to a mid- or higher-potency steroid, but only with careful monitoring for adverse effects. In practice, combine with good moisturization and barrier care, and reassess promptly to avoid prolonged use of potent steroids.