Preparations for Psoriasis

NHSL Medicines Guidance
NHS Lanarkshire

General Notes

For information on psoriasis management refer to The Dermatology Patient Pathways - Psoriasis and SIGN 121 Psoriasis and Psoriatic Arthritis Care Pathway.

The use of potent or very potent topical corticosteroids in psoriasis should be under specialist supervision. They can result in rebound relapse, development of generalised pustular psoriasis, and local and systemic toxicity in adults.

Vitamin D Analogue

Preferred list (P)

CALCIPOTRIOL ointment

  • For plaque psoriasis - maximum 100 g per week.

 

Total list (T)

CALCITRIOL ointment (Silkis®)

  • NHSL Dermatologists recommended use is for flexural and facial areas only.

 

Specialist initiation (S1)

CALCIPOTRIOL cutaneous solution

  • NHSL Dermatologists recommended use is for psoriasis under the nail only.

Vitamin D Analogue With POTENT Corticosteroid

Preferred list (P)

CALCIPOTRIOL WITH BETAMETHASONE cutaneous foam (Enstilar®)

  • Short term treatment – applied once daily, should not exceed 4 weeks unless advised by a specialist.
  • The daily maximum dose should not exceed 15g, i.e. one 60g container should last for at least 4 days. The total body surface area treated should not exceed 30%.

 

Total list (T)

CALCIPOTRIOL WITH BETAMETHASONE gel applicator (Dovobet®)

  • Short term treatment - applied once daily, should not exceed 4 weeks for scalp psoriasis and 8 weeks for mild/moderate plaque psoriasis, unless advised by a specialist.
  • The daily maximum dose should not exceed 15g. The total body surface area treated should not exceed 30%.

CALCIPOTRIOL WITH BETAMETHASONE ointment  

  • Short term treatment - applied once daily, should not exceed 4 weeks unless advised by a specialist.
  • The daily maximum dose should not exceed 15g. The total body surface area treated should not exceed 30%.

Prescribing Notes:

  • Potent to very potent topical corticosteroids are not recommended for regular use over prolonged periods because of concern over long term adverse effects (SIGN 121) 

Tars

Preferred list (P)

DISTILLED COAL TAR 6% cream (Psoriderm® Cream)

 

Total list (T)

COAL TAR 5% emulsion (Exorex® Lotion)

Prescribing notes:

  • Can be useful in the management of chronic plaque psoriasis or guttate psoriasis.

Dithranol

Preferred list (P)

DITHRANOL cream (Dithrocream®)

 

Total list (T)

DITHRANOL cream (Micanol®)

Prescribing Notes:

  • Can be useful in the management of chronic plaque psoriasis as short contact therapy. It is important to determine each patient's optimal treatment strength, as too high a strength may induce a burning sensation.
  • Not to be used on the face, or for acute or pustular psoriasis.

Salicylic Acid

Preferred list (P)

Salicylic acid 5% or 10% in yellow soft paraffin

  • Unlicensed product, available from NHS Scotland Pharmaceutical 'Specials' Service (previously Tayside Pharmaceuticals).

 

Preparations for Scalp

Please see section Chapter 13: Topical Corticosteroids.

Oral Retinoids

Specialist initiation (S2)

ACITRETIN

  • Due to a high risk of serious congenital malformations, oral Acitretin must not be used in pregnancy, and any use in women and girls must be within the conditions of a Pregnancy Prevention Programme. See MHRA Drug Safety Update for the new regulatory risk minimisation materials. 

 

NHSL Joint Adult Formulary Key

To indicate the category of a formulary medicine, updated sections adopt the following key:

Preferred list (P): First-line formulary choices.

Total list (T): Alternative choices when preferred list options not effective/not tolerated, or not indicated.

Specialist initiation (S1): Specialist initiation, or on the advice of a Consultant or Specialist Practitioner in this therapeutic area. Continuation in primary care is acceptable.

Specialist use only (S2): Supply via hospital, Homecare Service or a hospital based prescription (HBP) for dispensing by community pharmacy. Not prescribed in primary care setting.

Editorial Information

Last reviewed: 31/01/2022

Author(s): NHSL.

Version: Please refer to the introduction section for an explanation of the review dates above.

Approved By: ADTC

Reviewer name(s): ADTC.