Psoriasis

exp date isn't null, but text field is

Refer to section 13.5, National Patient PathwaysSIGN and British Association of Dermatology patient information leaflets 

Management of psoriasis with emollients only (refer to ‘Use of emollients’ guideline and section 13.2) may be adequate in mild or asymptomatic cases, as well as for maintenance between exacerbations.

Localised plaque

  • an emollient is important to lubricate skin at all times
  • the addition of a tar preparation may be appropriate in mild cases
  • alternatively, use short contact dithranol or topical vitamin D analogue and steroid.

Itchy plaques – consider alternating tar or calcitriol with moderately potent topical steroid (eg Betnovate-RD® ointment).

Hyperkeratotic – salicylic acid preparation, eg Diprosalic® ointment (also contains betamethasone dipropionate), in combination with tar or calcitriol and lukewarm olive oil to soften crusts. Diprosalic® ointment is for short-term use only and should not be used as maintenance treatment.

Flexural, facial, hair margin – if calcitriol irritates use a moderately potent topical steroid, eg clobetasone butyrate (Eumovate® ointment).

Guttate – emollient plus coal tar preparation (Exorex® lotion). Consider excluding streptococcal infection and referral if not settling after 6 weeks.

Scalp

  • application of lukewarm olive oil to scalp, leave at least 30 minutes to soften scale and wash out with tar-based shampoo (Alphosyl 2 in 1® or Capasal®). Refer to section 13.9.
  • if not itchy, use a descaling ointment such as Cocois® ointment, applied for 30 to 60 minutes before shampoo
  • if itchy, use short-term (up to 2 weeks) intermittent steroid lotion or scalp application.

Refer if: 

  • failure to respond adequately to above
  • more than 20% skin involved
  • stubborn guttate not responding to standard treatment after 6 weeks
  • unstable (pustular or inflamed) psoriasis.

Phototherapy

Although phototherapy is a first-line treatment for moderate to severe psoriasis it does not help all cases of psoriasis and must be carefully monitored. For these reasons, sunbeds should not be used for treatment.

 

Editorial Information

Last reviewed: 31 December 2016

Next review: 31 December 2018

Author(s): Skin Review Group

Version: 8

Approved By: high-uhb.tam@nhs.net