- 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.
- 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.
- 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.
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.