Psoriasis

Mild: localised plaques with limited impact on quality of life usually managed with topical treatment 

Assess lifestyle factors that may precipitate or aggravate psoriasis i.e. smoking, alcohol, obesity, certain medications and infections. 

Emollients – prescribe to soften scale (use fingertip measurement) 

Vitamin D with Steroid combined: 

• Ointment, Cream, Gel, Foam: Apply OD for 4 weeks, review and repeat as necessary 

Calcipotriol with Betamethasone preparations:  

Non-branded ointment  

Dovobet®, Dalonev®, Dalbecal® ointments Dovobet® gel  

Wynzora® cream 

Enstilar® foam  

Useful for plaques on body and limbs. Not suitable for face or flexures. 

Vitamin D preparations: 

• Calcipotriol (non-branded) ointment and l scalp solution apply OD/BD 

Calcipotriol (Dovonex®)  ointment apply OD/BD 

Calcitriol (Silkis®)  ointment apply BD 

Tacalcitol (Curatoderm®) ointment or  lotion apply BD. 

NB: Calcitriol and Tacalcitol may be less irritating than Calcipotriol and may be more suitable for sensitive areas like face and genitals. 

Topical Corticoteroids: 

• Mild: OD facial psoriasis 

Moderately potent: OD face and flexural areas 

Potent:  OD trunk/limbs, BD palms/soles 

Coal Tar Preparations: 

• Cream-Psoriderm® apply OD/BD 
• Lotion-Exorex® apply OD/BD 
• Shampoos: - Neutrogena T-Gel®, , Psoriderm®,  

Polytar®, Capasal® (with salicylic acid), use up to OD 

Coal Tar + Salicylic acid and Sulfur:  

• For scalp psoriasis mainly  

Cocois® ointment 100G apply up to OD 

Sebco® ointment 100G apply up to OD

Moderate psoriasis: Localised site or more widespread psoriasis > 10% body area 

Scalp psoriasis:  

• Prescribe a regimen of coconut, tar and salicylic ointment (Sebco/Cocois) applied OD for an hour or overnight and wash off with tar-based shampoo to soften and remove thick scale. Reduce frequency as improves. 
• Apply potent or very potent topical corticosteroid scalp solution / gel / foam (e.g. betamethasone +/- salicylic acid, clobetasol) OD after shampooing or, Vitamin D preparation, gel / foam OD, or corticosteroid + vitamin D (e.g. Dovobet® gel). 

Facial/Flexural psoriasis: 

• Steroids: mild/moderate potency topical corticosteroid OD 

Vitamin D preparations: Calcitriol / Tacalcitol OD/BD may be used as less irritant than Calcipotriol 

Calcineurin inhibitors (e.g Protopic®) may be helpful but should be initiated by specialist. 

Nail psoriasis:  

• Treatment difficult, keep trimmed, potent topical corticosteroid or Calcipotriol with Betamethasone combination OD may help 

PalmoPlantar Pustulosis: 

• Associated with smoking.  

Steroids, potent or very potent topical corticosteroids OD/BD 

Calcipotriol with Betamethasone combination ointment OD 

Guttate Psoriasis: 

• Widespread small plaques, self-limiting, often triggered 7-10 days after streptococcal URTI.  

Will often resolve spontaneously in weeks to months, useful treatments include: 

Mildly potent topical corticosteroid OD 

Vitamin D preparations OD 

Coal tar preparations OD 

• Refer to secondary care for consideration of phototherapy and/or first line systemic therapy with Methotrexate, Ciclosporin or Acitretin for moderate to severe psoriasis failing to respond to treatment. 

Treatment failures with phototherapy and first line systemic therapies may require novel systemic therapy with phosphodiesterase type-4 inhibitor (Apremilast) or biologic therapies. 

Severe psoriasis: Widespread inflamed psoriasis or severe localised recalcitrant psoriasis (e.g. palms and soles) or affecting high impact sites like face or groin. 

Refer same day to dermatology/ emergency care for erythrodermic or generalised pustular psoriasis 

Refer to rheumatology if any evidence of psoriatic arthropathy. 

Mild: localised plaques with limited impact on quality of life usually managed with topical treatment 

• Manage in primary care.  

Moderate psoriasis: Localised site or more widespread psoriasis > 10% body area 

• Refer routinely to secondary care service if failure of appropriate topical treatment after 4 weeks  

Severe psoriasis: Widespread inflamed psoriasis or severe localised recalcitrant psoriasis (e.g. palms and soles) or affecting high impact sites like face or groin.

• Consider referring urgently if psoriasis is very widespread and inflamed 
• Emergency referral is indicated for erythrodermic or generalised pustular psoriasis. 
• Refer to rheumatology if any evidence of psoriatic arthropathy. 

Validated tools used to evaluate psoriasis include: 

DLQI 

PASI 

Skin Diversity descriptors 

Physician’s Global assessment tool 

Cardiovascular assessment  

Psoriatic Arthritis screening tool- PEST 

NICE CKS- Psoriasis 

PCDS- Psoriasis 

DermNet NZ- Psoriasis 

• Patient preference for type of topical preparation should guide effective treatment 
• Psoriasis is a systemic disorder associated with an increased risk of cardiovascular disease; always assess cardiovascular risk factors. 
• Excess alcohol, smoking and obesity can make psoriasis more difficult to control. 
• Screen for arthritis and refer to rheumatology as needed. 

1. Patient info- Psoriasis see also Patient.info - fingertip unit guide
2. BAD leaflet - Psoriasis
3. BAD Patient Hub Psoriasis Overview: 
4. NHS Inform- Psoriasis
5. Psoriasis Association: 
6. NHS Information on Psoriasis: 
7. Mind Matters: Talk Psoriasis

Inflammatory 

ICD11 code - EA90.0          EA90.1