Topical Treatment of Plaque Psoriasis: A Five-Year Narrative Review of Prescription and Nonprescription Therapies
Updated: Sep 24
Ori Scott, M.Sc. NutritionRegistered Dietitian (Israel)Founder, Healthy Habits Coaching
Abstract
Background
Topical therapy remains an important component of psoriasis management, particularly in patients with limited plaque psoriasis and as adjunctive treatment in more extensive disease. Patients are presented with a broad spectrum of products ranging from prescription anti-inflammatory medications to nonprescription moisturizers, keratolytic preparations, coal-tar products, and creams promoted specifically for psoriasis. The quality of evidence supporting these products differs substantially.
Objective
To critically compare prescription and nonprescription topical treatments for plaque psoriasis using evidence published during the five years preceding September 11, 2026, with particular emphasis on clinically meaningful efficacy, safety, strength of evidence, and the distinction between established antipsoriatic therapy and supportive skin care.
Methods
A narrative review of PubMed/MEDLINE-indexed publications dated September 11, 2021 through September 11, 2026 was undertaken. Priority was given to randomized controlled trials, systematic reviews, meta-analyses, network meta-analyses, and clinically relevant evidence-based reviews. Search concepts included the Medical Subject Headings Psoriasis, Administration, Topical, Administration, Cutaneous, Dermatologic Agents, and Treatment Outcome, supplemented by drug- and ingredient-specific search terms. Prescription treatments included corticosteroids, vitamin-D analogues, corticosteroid/vitamin-D combinations, calcineurin inhibitors, retinoids, tapinarof, and roflumilast. Nonprescription interventions included moisturizers, ceramide-containing products, urea, salicylic acid, and coal tar. Products were not considered therapeutically equivalent merely because they were marketed for psoriasis. Older primary studies were excluded from the evidentiary analysis even when discussed in recent reviews.
Results
Within the five-year publication window, the most substantial new randomized evidence concerns the nonsteroidal topical agents roflumilast and tapinarof. Roflumilast 0.3% cream demonstrated significantly greater Investigator Global Assessment and Psoriasis Area and Severity Index responses than vehicle in randomized phase 3 trials, findings subsequently supported by systematic review and meta-analysis. Tapinarof 1% cream similarly demonstrated efficacy in phase 3 trials and subsequent long-term follow-up. Recent network meta-analyses support meaningful efficacy of both therapeutic aryl hydrocarbon receptor modulation and topical phosphodiesterase-4 inhibition.
Conventional treatments, including topical corticosteroids, vitamin-D analogues and their combinations, continue to be described in contemporary clinical reviews as established components of psoriasis treatment. However, under the strict five-year inclusion rule used in this review, much of their foundational randomized evidence predates the eligibility period and should not be represented as newly generated evidence.
For nonprescription products, recent evidence is more limited. Contemporary literature supports moisturizers primarily for barrier support, reduction in dryness and scaling, and adjunctive use. A recent observational study reported clinical improvement with a defined 40% urea/amino-inositol preparation, but the absence of a randomized control group limits conclusions regarding comparative efficacy. Recent reviews of coal tar acknowledge a historical clinical evidence base but emphasize the need for modern large randomized trials.
Conclusions
The evidence available from 2021–2026 does not support treating all topical psoriasis products as therapeutically equivalent. Roflumilast and tapinarof possess substantial contemporary randomized evidence of antipsoriatic activity. Established conventional therapies remain central to current clinical practice, although much of their pivotal evidence is older than the predefined review interval. Nonprescription moisturizers and keratolytic products have clinically relevant supportive roles but generally lack recent evidence demonstrating plaque-clearing efficacy comparable with prescription anti-inflammatory treatment. Patient education should distinguish direct antipsoriatic efficacy from improvement in hydration, scale, barrier function, or treatment acceptability.
Keywords: psoriasis; topical therapy; roflumilast; tapinarof; corticosteroids; moisturizers; urea; coal tar; nonprescription treatment; evidence-based dermatology
1. Introduction
Psoriasis is a chronic immune-mediated inflammatory disease affecting the skin and, in a proportion of patients, other organ systems. Topical treatment remains highly relevant in clinical practice because localized disease may be managed predominantly with local therapy, while patients receiving systemic treatment may continue to require topical agents for residual lesions.
A particular difficulty for patients is the large number of products presented as treatments for psoriasis. Prescription corticosteroids, vitamin-D derivatives, newer nonsteroidal agents, moisturizers, keratolytics and coal-tar preparations may occupy adjacent pharmacy shelves or appear together in online searches despite representing fundamentally different therapeutic categories.
The word “works” can also have several meanings. A treatment may directly reduce psoriatic inflammation and produce plaque clearance; another may primarily soften scale or improve xerosis; a third may improve comfort without materially altering the inflammatory process. These outcomes should not be treated as interchangeable.
The present review was designed to provide a patient-relevant but academically rigorous comparison based exclusively on publications from the preceding five years. The deliberate restriction to recent literature provides a contemporary assessment but also creates an important limitation: foundational evidence for older therapies may fall outside the inclusion interval even though those therapies remain established in clinical practice.
2. Methods
2.1 Review design
This article was prepared as a narrative review rather than a systematic review or meta-analysis.
Eligible literature was restricted to publications dated from September 11, 2021 through September 11, 2026.
PubMed/MEDLINE was used as the principal bibliographic database. Preference was given to:
randomized controlled trials;
systematic reviews;
meta-analyses;
network meta-analyses;
long-term clinical extensions;
evidence-based clinical reviews relevant to topical psoriasis management.
Older individual clinical trials were excluded even when they represented historically important evidence.
2.2 PubMed and MeSH strategy
Principal concepts included:
“Psoriasis”[MeSH]
“Psoriasis/drug therapy”[MeSH]
“Administration, Topical”[MeSH]
“Administration, Cutaneous”[MeSH]
“Dermatologic Agents”[MeSH]
“Treatment Outcome”[MeSH]
Drug- and product-specific terms included:
roflumilast;
tapinarof;
corticosteroid;
betamethasone;
clobetasol;
calcipotriene;
calcipotriol;
vitamin D analogue;
tazarotene;
tacrolimus;
pimecrolimus;
moisturizer;
emollient;
ceramide;
urea;
salicylic acid;
coal tar.
A representative search structure was:
("Psoriasis"[MeSH] OR psoriasis[Title/Abstract]) AND ("Administration, Topical"[MeSH] OR "Administration, Cutaneous"[MeSH] OR topical[Title/Abstract])
For higher-level evidence:
("Psoriasis"[MeSH] OR psoriasis[Title/Abstract]) AND topical[Title/Abstract] AND ("Randomized Controlled Trial"[Publication Type] OR "Systematic Review"[Publication Type] OR "Meta-Analysis"[Publication Type])
The PubMed publication-date filter was restricted to the predefined five-year interval.
3. A Necessary Distinction: Established Therapy Versus Recent Evidence
The five-year restriction requires a distinction that is often omitted in narrative reviews.
Topical corticosteroids and vitamin-D analogues did not become established psoriasis treatments during the last five years. Their principal randomized evidence was generated over a much longer period.
A contemporary review applying current topical psoriasis recommendations describes corticosteroids, calcineurin inhibitors, vitamin-D analogues, tazarotene, emollients, salicylic acid, anthralin, and coal tar as components of topical management. [1]
This contemporary recognition should not, however, be mistaken for new randomized evidence generated during 2021–2026.
The recent evidence base is particularly informative for newer agents—most notably roflumilast and tapinarof—because their pivotal clinical development occurred within or close to the specified publication interval.
4. Roflumilast
Roflumilast is a selective phosphodiesterase-4 inhibitor formulated as a topical cream for plaque psoriasis.
The phase 3 DERMIS-1 and DERMIS-2 randomized clinical trials provide high-quality evidence for its efficacy. In these studies, roflumilast 0.3% cream was applied once daily and compared with vehicle treatment.
At week 8, Investigator Global Assessment success occurred substantially more frequently with roflumilast than with vehicle. Significant differences were also observed in PASI-based endpoints.
Subsequent systematic review and meta-analysis strengthened these findings. A 2024 analysis incorporated four randomized controlled trials and 1,403 patients, of whom 885 received roflumilast.
At week 8, roflumilast was associated with a relative risk of 5.07 for IGA or body-IGA success compared with vehicle (95% CI 3.55–7.23). PASI-75 was also significantly more likely with roflumilast (RR 4.48; 95% CI 2.26–8.89).
Intertriginous psoriasis was particularly responsive in the pooled analysis. Intertriginous IGA success at week 8 was reported in 71.9% of roflumilast-treated participants compared with 20.5% receiving vehicle.
The meta-analysis found no significant difference between groups in treatment-related adverse events, serious adverse events, or adverse events leading to discontinuation.
These results provide strong contemporary evidence that topical roflumilast has direct antipsoriatic efficacy.
An important limitation should nevertheless be communicated to patients: superiority to vehicle is not synonymous with superiority to every established topical medication.
5. Tapinarof
Tapinarof is a nonsteroidal aryl hydrocarbon receptor agonist developed specifically as a topical anti-inflammatory treatment.
The phase 3 PSOARING program provides recent randomized evidence supporting tapinarof 1% cream for plaque psoriasis.
Two randomized phase 3 trials demonstrated significantly greater Physician Global Assessment treatment success with tapinarof than with vehicle.
Long-term follow-up subsequently provided evidence regarding durability of response and repeated treatment.
Tapinarof is therefore supported by substantially stronger contemporary evidence than typical nonprescription creams marketed for psoriasis.
Adverse effects reported with tapinarof include folliculitis and contact dermatitis, which should form part of patient counseling.
As with roflumilast, the strongest evidence is derived primarily from controlled comparison with vehicle rather than large direct comparisons against every established potent topical therapy.
6. Comparative Evidence for Newer Topical Drugs
A 2024 systematic review and network meta-analysis compared newer topical therapies including therapeutic aryl hydrocarbon receptor-modulating agents, phosphodiesterase-4 inhibitors, and topical JAK-STAT pathway inhibitors.
The analysis found that therapeutic aryl hydrocarbon receptor-modulating regimens and roflumilast increased the likelihood of achieving PGA response and PASI-75 compared with vehicle.
The investigators concluded that roflumilast demonstrated a favorable combination of efficacy and safety, while aryl hydrocarbon receptor-modulating treatment demonstrated substantial efficacy accompanied by a higher frequency of adverse events in the included evidence.
A separate network meta-analysis of tapinarof published within the review interval reported superiority of tapinarof to placebo and, indirectly, to calcipotriol in the analyzed network.
Such indirect comparisons should be interpreted more cautiously than direct head-to-head randomized comparisons.
7. Conventional Prescription Topical Therapy
7.1 Corticosteroids
Topical corticosteroids remain an established component of psoriasis treatment and are included in contemporary clinical treatment reviews.
Within the strict five-year publication window, however, the literature primarily consists of contemporary reviews and practice discussions rather than the foundational placebo-controlled trials that originally established efficacy.
It would therefore be methodologically incorrect for this five-year review to assign new numerical response rates to corticosteroids using substantially older trials.
The appropriate conclusion is that topical corticosteroids remain established standard therapy, while this review does not re-analyze their older pivotal efficacy database.
7.2 Vitamin-D analogues
Calcipotriene/calcipotriol and related vitamin-D analogues remain recognized topical treatments.
Again, much of their definitive randomized comparative evidence precedes the five-year inclusion interval.
They should therefore be described as established therapies supported by a historical evidence base and maintained in contemporary treatment frameworks—not as treatments whose principal efficacy was newly established during 2021–2026.
7.3 Corticosteroid/vitamin-D combinations
Fixed combinations of a potent corticosteroid with a vitamin-D analogue remain clinically important.
Contemporary literature continues to discuss their use, but the strict publication criterion prevents this review from relying on older pivotal trials to provide comparative response percentages.
This methodological restraint is important because a narrative review should not selectively disregard its own date restriction when discussing familiar therapies.
8. Nonprescription Products: What Does Recent Research Actually Support?
The nonprescription category is the area in which patient expectations and clinical evidence may differ most markedly.
A product being sold in a pharmacy, carrying the word “psoriasis” on its packaging, or containing an ingredient historically used for psoriasis does not establish that the particular commercial formulation has demonstrated antipsoriatic efficacy in a randomized clinical trial.
Recent evidence allows several categories to be distinguished.
9. Moisturizers and Gentle Skin Care
A 2023 review specifically addressing psoriasis, skin-barrier dysfunction, cleansers and moisturizers concluded that moisturizers may have an adjunctive role during active treatment and a supportive role in maintenance of healing skin.
The review noted evidence involving products containing ingredients such as ceramides and salicylic acid and emphasized effects including softening of plaques and support of the epidermal barrier.
However, the authors also identified an important evidence gap regarding skin-barrier care in psoriasis.
This distinction is clinically important.
Moisturizers may:
reduce dryness;
soften scale;
improve skin feel and comfort;
support barrier function;
facilitate use of other topical treatments.
These effects do not establish equivalence to prescription anti-inflammatory drugs for plaque clearance.
Accordingly, conventional moisturizers should be characterized as supportive or adjunctive therapy, not as proven substitutes for medications such as roflumilast, tapinarof, potent corticosteroids, or vitamin-D/corticosteroid combinations.
10. Urea Preparations
Urea is commonly available without prescription in creams and lotions at different concentrations.
A 2022 observational study evaluated a specific formulation containing 40% urea and amino-inositol in patients with mild psoriasis who were not using other associated cosmetic or pharmacologic treatments during the observation period.
After four weeks, the authors reported reductions in several clinical measures, including PASI, body-surface-area involvement, plaque score, physician global assessment, pruritus-related visual analogue score and Dermatology Life Quality Index.
No significant adverse effects were reported.
These results are clinically interesting but should not be overinterpreted.
The study was observational rather than randomized and did not provide a placebo- or active-treatment comparator. Consequently:
it demonstrates an association between use of that particular formulation and clinical improvement;
it does not establish superiority to vehicle;
it does not establish equivalence to prescription psoriasis medications;
its findings cannot automatically be generalized to every commercially available urea cream.
A 2025 systematic review evaluating topical urea across several dermatological diseases also reported beneficial effects on dryness, scaling, transepidermal water loss and related skin outcomes. The included evidence was heterogeneous and was not restricted to psoriasis.
For patients, urea is therefore best regarded as a potentially valuable moisturizing and keratolytic intervention, with more limited contemporary evidence for direct psoriasis clearance than the principal prescription therapies.
11. Salicylic Acid
Salicylic acid remains used as a keratolytic agent in psoriasis and is available in nonprescription preparations in some markets.
Its principal therapeutic purpose is removal or softening of scale.
Contemporary clinical reviews continue to include salicylic acid among adjunctive topical options.
Within the present five-year evidence window, however, robust new randomized evidence demonstrating salicylic acid monotherapy to be comparable with modern prescription anti-inflammatory drugs was not identified.
Therefore, salicylic acid should not be marketed or interpreted as equivalent to a medication whose primary action is suppression of psoriatic inflammation.
Its evidence-based role is better characterized as keratolytic and adjunctive.
12. Coal Tar
Coal tar remains one of the oldest topical approaches used for psoriasis and is still present in some nonprescription shampoos, lotions and other preparations.
A 2022 review reassessed tar therapy in psoriasis and identified continuing mechanistic and clinical interest.
Importantly, the authors concluded that large, randomized, double-blind controlled trials remain necessary to establish the place of tar preparations in modern psoriasis treatment.
This is a highly relevant conclusion for consumer interpretation.
Coal tar has a historical dermatologic evidence base, but within a review deliberately restricted to the last five years, there is insufficient contemporary high-quality evidence to rank commercial coal-tar products alongside newer agents studied in large phase 3 programs.
The review also highlights that “tar” is not a single standardized intervention. Coal-derived and other tar preparations differ chemically, making inappropriate generalization between products particularly problematic.
13. Ceramide-Containing Products
Ceramides are biologically plausible components of supportive skin-barrier care, and recent reviews discuss ceramide-containing moisturizers in psoriasis.
However, the strongest individual psoriasis trials evaluating specific ceramide/linoleic-acid moisturizers were published before the present five-year eligibility window.
Those older trials were therefore deliberately excluded from the primary evidence analysis.
On the basis of recent literature alone, ceramide-containing moisturizers can reasonably be recommended as barrier-supportive adjuncts, but a claim of antipsoriatic efficacy equivalent to prescription treatment would exceed the evidence considered in this review.
14. Botanical and “Natural” Products
A strict five-year literature restriction also changes how botanical preparations should be handled.
Older controlled studies exist for some botanical products, including aloe vera, but they fall outside the present review period.
No recent evidence identified in the five-year review justifies ranking commonly sold aloe-based psoriasis creams alongside prescription medications supported by contemporary phase 3 trials.
This does not establish that every botanical preparation is ineffective.
It means that evidence sufficient for inclusion as a contemporary evidence-based alternative was not identified under the present eligibility criteria.
Absence of qualifying evidence and evidence of absence should not be conflated.
15. Brand Names Versus Active Ingredients
A patient-facing comparison should avoid ranking pharmacy brands solely according to advertising claims.
Clinical evidence usually applies to a defined combination of:
active ingredient;
concentration;
pharmaceutical vehicle;
application frequency;
treatment duration;
patient population.
A randomized trial of one 40% urea/amino-inositol formulation, for example, is not evidence that every cream containing urea at any concentration produces the same result.
Similarly, evidence for coal tar as a therapeutic category cannot establish that every coal-tar shampoo or lotion has equivalent potency or efficacy.
For this reason, pharmacy products should be evaluated primarily by their active ingredient and formulation, with brand names used only when the actual commercial product itself has been adequately studied.
16. Comparative Evidence Table
Intervention | Evidence published 2021–2026 | What recent evidence supports | Appropriate interpretation |
Roflumilast 0.3% cream | Phase 3 RCTs; systematic review/meta-analysis | Significant improvement in IGA and PASI outcomes versus vehicle | Strong contemporary evidence |
Tapinarof 1% cream | Phase 3 RCTs; long-term study; reviews/NMA | Significant plaque improvement versus vehicle; evidence of durable response in extension study | Strong contemporary evidence |
Topical corticosteroids | Contemporary reviews/practice guidance | Continued standard role | Established therapy; pivotal evidence largely predates review interval |
Vitamin-D analogues | Contemporary reviews | Continued established role | Established therapy; pivotal evidence largely predates review interval |
Vitamin-D/corticosteroid combinations | Contemporary reviews | Continued established role | Established therapy; much foundational evidence older |
Calcineurin inhibitors | Contemporary treatment reviews | Specialized/off-label role, especially sensitive sites | Established site-specific option; recent comparative evidence limited |
Tazarotene | Contemporary reviews | Recognized topical retinoid | Established therapy; pivotal trials outside current window |
Moisturizers/emollients | 2023 review | Barrier support, plaque softening, adjunctive care | Supportive evidence |
Ceramide-containing moisturizers | Recent review-level discussion | Barrier support and adjunctive role | Supportive; recent RCT evidence limited |
40% urea + amino-inositol cream | 2022 observational study | Clinical improvement during four weeks of treatment | Promising but uncontrolled evidence |
Urea generally | 2025 systematic review across dermatologic diseases | Improvement in xerosis/scaling/barrier-related outcomes | Supportive/keratolytic role |
Salicylic acid | Contemporary reviews | Scale removal and adjunctive use | Keratolytic; insufficient recent evidence for equivalence to prescription anti-inflammatory therapy |
Coal tar | 2022 contemporary review | Historical efficacy recognized; need for modern trials emphasized | Potentially active but insufficient contemporary comparative evidence |
Aloe vera/other botanical OTC creams | No adequate recent evidence identified for routine ranking | No contemporary basis for equivalence to established medications | Insufficient five-year evidence |
17. What “Works” Means for a Patient
The evidence suggests three clinically useful categories.
17.1 Direct antipsoriatic treatment with strong recent evidence
Roflumilast and tapinarof have contemporary randomized trial programs demonstrating direct improvement of plaque psoriasis.
17.2 Established antipsoriatic treatment supported substantially by older foundational evidence
This category includes topical corticosteroids, vitamin-D analogues and several long-established prescription approaches.
Their exclusion from a list of “new five-year trials” should not be interpreted as evidence that they are ineffective.
It reflects the date restriction of the present review.
17.3 Supportive skin-care and keratolytic treatment
Moisturizers, urea-containing products and salicylic-acid preparations may improve:
dryness;
scale;
skin-barrier function;
comfort;
application of accompanying medications.
These outcomes can be clinically valuable without constituting equivalent anti-inflammatory efficacy.
18. Implications for Pharmacy Consumers
A patient choosing between products should consider four questions.
First, has the exact active treatment been tested in patients with psoriasis?
Second, was it tested against an inactive vehicle, an effective treatment, or not compared at all?
Third, what endpoint improved? Reduced dryness is not the same endpoint as achieving clear or almost-clear skin.
Fourth, does the evidence apply to the actual product being purchased?
These questions help prevent a common error in consumer health information: treating evidence for an ingredient, mechanism or product category as evidence for every commercial formulation containing that ingredient.
19. Limitations
This review has several deliberate limitations.
The five-year publication restriction increases contemporaneity but excludes much of the foundational randomized literature for established treatments including topical corticosteroids, vitamin-D analogues, tazarotene, salicylic acid, coal tar and several moisturizer formulations.
Consequently, absence of recent randomized trials should not be interpreted as proof of ineffectiveness.
Second, this is a narrative review and does not provide the exhaustive study identification, duplicate screening, formal risk-of-bias assessment or quantitative synthesis expected of a systematic review.
Third, newer medications have an inherent advantage in a review based on publication date because contemporary phase 3 trials are concentrated around regulatory development.
Fourth, substantial heterogeneity exists among study endpoints. IGA success, PGA success and PASI responses cannot be treated as identical measures.
Fifth, vehicle-controlled trials establish efficacy relative to the formulation vehicle but do not establish superiority over all active topical treatments.
Finally, evidence for nonprescription products is frequently formulation-specific and should not be generalized to unrelated commercial products.
20. Conclusion
The topical psoriasis literature published during the five years ending September 11, 2026 demonstrates a clear difference between treatments supported by contemporary randomized clinical evidence and products supported primarily as adjunctive skin care.
Roflumilast and tapinarof possess the strongest recent clinical-development evidence among newer topical therapies. Both have demonstrated significant improvement in plaque psoriasis in randomized controlled trials and have subsequently been evaluated in reviews and comparative evidence syntheses.
Conventional topical corticosteroids, vitamin-D analogues and their combinations remain established treatments, although much of the research that originally established their efficacy predates the deliberately restricted publication interval used in this review.
For pharmacy-available nonprescription products, recent evidence supports a more cautious interpretation. Moisturizers and ceramide-containing products can contribute to barrier care and plaque softening. Urea has moisturizing and keratolytic properties, and a specific 40% urea/amino-inositol formulation demonstrated encouraging results in an observational psoriasis study. Salicylic acid has an established keratolytic role. Coal tar remains biologically and historically relevant, but contemporary reviewers continue to call for larger modern randomized trials.
Accordingly, nonprescription topical products should not be characterized as equivalent to prescription antipsoriatic medication unless comparative clinical evidence demonstrates such equivalence.
For patients, the most scientifically defensible distinction is not simply between prescription and over-the-counter treatment. It is between direct antipsoriatic therapy, established therapy supported substantially by older evidence, and supportive products that primarily improve scale, hydration, barrier function or treatment tolerability.
Declarations
Author
Ori Scott, M.Sc. NutritionRegistered Dietitian (Israel)Founder, Healthy Habits Coaching
Funding
This work received no external funding. The author received no financial or commercial support for the preparation of this review.
Conflicts of Interest
The author declares no financial or non-financial conflicts of interest relevant to this manuscript.
Author Contributions
Ori Scott conceived the review topic and scope, defined the research questions and eligibility criteria, evaluated and interpreted the literature, critically revised the manuscript, and approved the final version. The author accepts full responsibility for the accuracy, integrity, interpretation, and conclusions of the work.
Ethics Approval
Not applicable. This narrative review analyzes previously published literature and involved no recruitment of human participants, collection of identifiable personal information, or original intervention involving human or animal subjects.
Consent to Participate
Not applicable.
Consent for Publication
Not applicable.
Data Availability
No original participant-level data were collected or generated for this review. The evidence discussed in the manuscript is derived from publicly available peer-reviewed publications cited in the reference list.
Acknowledgments
The author independently developed the review concept, selected the subject matter, evaluated the evidence, and retains full responsibility for the scientific interpretation and final manuscript.
Declaration of AI-Assisted Technologies
During manuscript preparation, the author used OpenAI ChatGPT as an assistive tool for drafting, language refinement, organization, and presentation of material. The literature selection, assessment of evidence, interpretation of findings, verification of scientific claims and references, critical revision, and final approval remain the responsibility of the author. AI-generated output was reviewed and edited by the author and was not treated as an independent scientific source or author.
The author accepts full responsibility for the content of the final manuscript.
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