Systemic biological agents for psoriasis
Systemic biological agents for psoriasis management, listed elsewhere in the formulary:
Topical preparations for psoriasis
Topical preparations used for psoriasis management, listed elsewhere in the formulary:
Vitamin D and analogues
Calcipotriol
- Ointment 50micrograms/g (£7.94 = 30g)
Indications
Dose
- Adults: Apply once or twice daily for 4 weeks (maximum 100g per week)
- Children aged 12 to 17 years: Apply once or twice daily for 4 weeks (maximum 75g per week) (unlicensed)
- Children aged 6 to 11 years: Apply once or twice daily for 4 weeks (maximum 50g per week) (unlicensed)
Notes
- Treatment may be continued beyond 4 weeks or repeated, on the advice of a specialist
- The unlicensed use of calcipotriol in children is supported by BNFC, NICE CG153, and local specialists
Calcipotriol / Betamethasone dipropionate
- Ointment (calcipotriol 0.005% / betamethasone dipropionate 0.05%) (£19.84 = 30g)
- Gel (calcipotriol 0.005% / betamethasone dipropionate 0.05%) (£18.53 = 60g)
- Foam (calcipotriol 50micrograms/g / betamethasone dipropionate 500micrograms/g) (£39.68 = 60g, £79.36 = 120g)
Indications and dose
- Psoriasis
- Ointment, Gel, or Foam: Apply once daily for 4 weeks; maximum 15g per day
- Scalp psoriasis
- Gel and Foam: Apply once daily for 4 weeks
Notes
- Treatment may be continued beyond 4 weeks or repeated, on the advice of a specialist
- Apply to a maximum 30% of body surface
- Maximum total calcipotriol 5mg in any one week
- One 60g can of foam should last for at least 4 days; a two-second depression of the can actuator delivers approximately 0.5g. As a guide, 0.5g of foam should cover an area of skin roughly corresponding to the surface area of an adult hand
- Calcipotriol monohydrate / betamethasone dipropionate foam is contraindicated in generalised pustular psoriasis
Calcitriol
(3micrograms/g)
Indications
Dose
- Apply once or twice daily for 4 weeks, maximum 30g daily
Notes
- Calcitriol should be used for those patients not responding to calcipotriol
- Not more than 35% of body surface to be treated daily
Tars
Psoriderm scalp lotion
(Coal tar distilled 25 mg/ml)
- Scalp lotion (£4.74 = 250ml)
Indications
Dose
- Apply to scalp as required to remove adherent scale
Notes
- Useful in softening thick adherent scale on the surface of the psoriasis plaques
Exorex lotion
(Coal tar solution 50mg/g)
- Cutaneous emulsion (£8.11 = 100ml, £16.24 = 250ml)
Indications
Dose
- Apply to skin or scalp 2–3 times daily
Notes
- Useful in softening thick adherent scale on the surface of the psoriasis plaques
- Lotion can be diluted with a few drops of water before applying
Tar with lecithin
Psoriderm cream
(Coal tar distilled 60 mg/g / Lecithin 4 mg/g)
Indications
Dose
- Apply to skin or scalp once or twice daily
Notes
- Useful in softening thick adherent scale on the surface of the psoriasis plaques
Tar with salicylic acid
Sebco
(Coal tar solution 120mg/g / Salicylic acid 20mg/g / Sulfur precipitated 40mg/g)
Indications
Dose
- Adults and children ≥ 12 years: Apply as required (if severe use daily for first 3-7 days), shampoo off after 1 hour
- Children aged 6 to 11 years: Apply once weekly as required
Notes
- Useful in softening thick adherent scale on the surface of the psoriasis plaques
Cocois
(Coal tar solution 120mg/g / Salicylic acid 20mg/g / Sulfur precipitated 40mg/g)
Indications
Dose
- Adults and children ≥ 12 years: Apply as required (if severe use daily for first 3-7 days), shampoo off after 1 hour
- Children aged 6 to 11 years: Apply once weekly as required
Notes
- Useful in softening thick adherent scale on the surface of the psoriasis plaques
Tar with corticosteroid (unlicensed preparations)
Coal tar / betamethasone valerate
- Coal tar solution 5% in betamethasone valerate 0.025% ointment 100g
Notes
- Preparation included as specials recommended by the British Association of Dermatologists (BAD) for skin disease
Oral preparations for psoriasis
Oral systemic non-biological agents for psoriasis management, listed elsewhere in the formulary:
Oral retinoids for psoriasis
Acitretin
Notes
- Specific information regarding oral acitretin and the use of remote consultations for monitoring safety requirements (from the Medicines and Healthcare products Regulatory Agency (MHRA)) during the Coronavirus (COVID-19) pandemic can be found here.
- Due to a high risk of serious congenital malformations, acitretin must not be used in pregnancy, and any use in women and girls must be within the conditions of a Pregnancy Prevention Programme (PPP)
- Acitretin has a substantially longer half-life and duration of effect than either isotretinoin or alitretinoin, and therefore the PPP measures must be undertaken for longer
- Patients treated with an oral retinoid should be monitored or signs of depression or suicidal ideation and referred for appropriate treatment, if necessary; particular care needs to be taken in patients with history of depression
- Advise patients taking an oral retinoid that they may experience changes in their mood or behaviour and that they should speak to their doctor if their mood is affected; they should be encouraged to let family and friends know they are taking an oral retinoid so they can look out for any change in mood
- MHRA Drug Safety Update (June 2019): Oral retinoid medicines: revised and simplified pregnancy prevention educational materials for healthcare professionals and women, and advice about the risk of neuropsychiatric reactions
- See also resources for: contraception for drugs with teratogenic potential, and prescribing in pregnancy and lactation