Best Steroid-Free Psoriasis Creams (2026): Prescription and Natural Options Compared
Psoriasis treatment guide
Part of our Psoriasis guide
The steroid-free psoriasis creams with the strongest evidence are prescription tapinarof and roflumilast, which cleared or almost cleared plaques in about 35% to 42% of people in large trials, and vitamin D creams such as calcipotriol. Over the counter, coal tar and salicylic acid are guideline-backed. Among plant-based options, indigo naturalis, Mahonia aquifolium and topical Chinese herbal formulas with Ku Shen have encouraging but smaller studies.
- Tapinarof and roflumilast are newer prescription steroid-free creams with phase 3 trial evidence.
- Coal tar and salicylic acid are over-the-counter options in US guidelines.
- Indigo naturalis had the strongest plant-based trial: 74% clearance or near clearance of treated plaques.
- Topical Chinese herbal formulas improved psoriasis in a meta-analysis, with Ku Shen among the most used herbs.
- Widespread psoriasis or joint pain needs a dermatologist.
Why look for a steroid-free psoriasis cream?
Topical steroids are the most common first treatment for psoriasis, but plaques often return when they are stopped, and long-term use can thin the skin, especially on the face and in skin folds. Many people therefore want a steroid-free cream for daily maintenance, for sensitive areas, or to use between steroid courses. US guidelines include several non-steroid topical options (Elmets et al., 2021).
Steroid-free psoriasis creams compared
Below are the main steroid-free options, grouped by type. Evidence varies widely, from large phase 3 trials for prescription creams to small studies for plant-based products.
| Option | Type | What the evidence shows | Things to know |
|---|---|---|---|
| Tapinarof 1% cream | Prescription | Clear or almost clear skin in 35% to 40% of patients after 12 weeks vs about 6% with placebo cream (Lebwohl 2021) | Can cause folliculitis and headache |
| Roflumilast 0.3% cream | Prescription | Clear or almost clear in 38% to 42% after 8 weeks vs 6% to 7% with placebo, including skin folds (Lebwohl 2022) | Once daily; suits folds and face |
| Calcipotriol (vitamin D) cream | Prescription | A long-standing first-line non-steroid psoriasis cream in guidelines | Can irritate; limits on how much to use |
| Tacrolimus or pimecrolimus | Prescription (off-label) | Used by dermatologists for face and skin-fold psoriasis | May sting at first |
| Coal tar | Over the counter | Recommended in US guidelines for plaque and scalp psoriasis | Smell and staining |
| Salicylic acid | Over the counter | Softens and lifts scale so other treatments work better | Can irritate if overused |
| Indigo naturalis (Qing Dai) ointment | Plant-based | 74% of patients had clearance or near clearance of the treated plaque in a 12-week controlled trial (Lin 2008) | Stains skin and clothes blue; hard to find |
| Mahonia aquifolium 10% cream | Plant-based | Improved mild to moderate psoriasis in open-label studies (Gulliver 2005) | Mostly uncontrolled studies |
| Topical Chinese herbal formulas (with Ku Shen and similar herbs) | Plant-based | A meta-analysis found topical herbal formulas improved psoriasis compared with controls, with Sophora root (Ku Shen) among the most used herbs (Deng 2014) | Choose brands with a published steroid test |
| Moisturisers and urea creams | Over the counter | Soften plaques and reduce itch and cracking | Support, not a stand-alone treatment |
A steroid-free daily cream for itchy plaques. QICAOGANGMU combines Ku Shen and She Chuang Zi with cooling menthol and borneol, tested steroid-free by TÜV SÜD PSB. Rated 4.5 to 4.7 out of 5 on Amazon. See the formula
Which plant-based creams have the best evidence?
Of the plant-based options, indigo naturalis has the strongest controlled trial evidence, followed by Mahonia aquifolium and topical Chinese herbal formulas. Their studies are smaller and shorter than the trials for prescription creams, so they suit mild to moderate psoriasis, maintenance between prescription courses, or people who prefer to avoid steroids, rather than severe or widespread disease. Read more in herbal remedies for psoriasis and our Ku Shen research guide.
How do you choose the right steroid-free psoriasis cream?
| Your situation | Options to consider |
|---|---|
| Thick, scaly plaques on elbows and knees | Salicylic acid to lift scale, then a treatment cream; ask about vitamin D or tapinarof |
| Face, armpits, groin or under the breasts | Roflumilast, tacrolimus or a gentle steroid-free cream; avoid strong acids and tar |
| Scalp psoriasis | Coal tar or salicylic acid shampoo plus a scalp treatment |
| Itchy plaques you want to calm daily | Moisturiser plus a cooling steroid-free cream |
| Widespread psoriasis or joint pain | See a dermatologist: tablets, injections or light therapy may be needed |
How does TCM approach psoriasis creams?
In Traditional Chinese Medicine, bright red, spreading plaques reflect Blood Heat, while dry, scaly plaques reflect Blood Dryness. External treatment uses cooling herbs such as Qing Dai (indigo naturalis) and Ku Shen for heat and itch, together with moistening bases for dryness. See psoriasis in Chinese and Western medicine.
When should you see a doctor?
- Psoriasis covers a large area, or creams are not helping after 4 to 8 weeks.
- You have joint pain, swelling or morning stiffness.
- Plaques are in the genitals or around the eyes.
- The skin becomes widely red, hot or pustular, which needs urgent care.
Where QICAOGANGMU fits
QICAOGANGMU Steroid-Free Herbal Cream
4.7/5 (243 ratings) and 4.5/5 (685 ratings) on Amazon. Read reviews
QICAOGANGMU is a steroid-free cream for itchy, dry or scaly patches. It contains Ku Shen 1.5%, one of the most used herbs in topical Chinese psoriasis formulas, with She Chuang Zi 3%, cooling Bing Pian (borneol) 2% and menthol 0.5%, and Bai Bu 0.5%, in a moisturising petrolatum base that softens scale. It has not been tested in its own psoriasis trial; it is designed for daily comfort and maintenance alongside your doctor's plan.
- Steroid-free: TÜV SÜD PSB found none of 8 corticosteroids (lab reports)
- Fully declared formula: every active ingredient and its percentage on the label
- 100-day money-back guarantee
- US shipping in 2 to 6 business days, free over US$15
Just trying it? Buy 1 tube for US$9.50. Free US shipping over US$15.
Patch test first and apply a thin layer to intact skin. Avoid the eyes, lips, genitals and broken skin. Not for children under 2. QICAOGANGMU at a glance · Product details
Free guide: The 7-Day Itch Relief Plan
One simple step a day to calm itchy skin and sleep better, from our herbal science researcher. Get the 10-page PDF:
- Daily checklists and an itch diary
- Dermatology and TCM tips side by side
- A bedtime routine for night-time itch
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Frequently asked questions
What is the best steroid-free cream for psoriasis?
For prescription options, tapinarof and roflumilast creams have the strongest recent trial evidence. Over the counter, coal tar and salicylic acid are guideline-backed, and plant-based creams such as indigo naturalis and herbal formulas have smaller supporting studies.
Is there a natural cream that works for psoriasis?
Indigo naturalis ointment, Mahonia aquifolium cream and topical Chinese herbal formulas have shown benefit in studies, mostly for mild to moderate psoriasis. Results vary, and they work best with daily moisturising.
Can I use a steroid-free cream on facial psoriasis?
Yes, steroid-free options are often preferred on the face. Doctors commonly use roflumilast, tacrolimus or pimecrolimus there. Keep menthol and borneol creams away from the eyes.
Do steroid-free creams work as fast as steroids?
Usually not. Steroids act quickly, while steroid-free creams often need 4 to 12 weeks. Many people use a steroid briefly for a flare and a steroid-free cream for maintenance.
Is coal tar safe for psoriasis?
Coal tar has been used for over a century and is included in US guidelines. It can irritate, smells strong and stains, so it is often used at night or in shampoos.
Related articles
References
- Elmets CA, Korman NJ, Prater EF, et al. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with topical therapy and alternative medicine modalities for psoriasis severity measures. J Am Acad Dermatol. 2021;84(2):432-470. PMID 32738429
- Lebwohl MG, Stein Gold L, Strober B, et al. Phase 3 trials of tapinarof cream for plaque psoriasis. N Engl J Med. 2021;385(24):2219-2229. PMID 34879448
- Lebwohl MG, Kircik LH, Moore AY, et al. Effect of roflumilast cream vs vehicle cream on chronic plaque psoriasis: the DERMIS-1 and DERMIS-2 randomized clinical trials. JAMA. 2022;328(11):1073-1084. PMID 36125472
- Lin YK, Chang CJ, Chang YC, et al. Clinical assessment of patients with recalcitrant psoriasis in a randomized, observer-blind, vehicle-controlled trial using indigo naturalis. Arch Dermatol. 2008;144(11):1457-1464. PMID 19015420
- Gulliver WP, Donsky HJ. A report on three recent clinical trials using Mahonia aquifolium 10% topical cream and a review of the worldwide clinical experience with Mahonia aquifolium for the treatment of plaque psoriasis. Am J Ther. 2005;12(5):398-406. PMID 16148424
- Deng S, May BH, Zhang AL, et al. Topical herbal formulae in the management of psoriasis: systematic review with meta-analysis. Phytother Res. 2014;28(4):480-497. PMID 23817996
Educational information only. This article does not replace medical advice. Psoriasis that is widespread, painful, pustular or linked with joint symptoms needs a doctor.
