Topical preparations for psoriasis
Vitamin D and analogues
Irritant preparations (tar, dithranol, vitamin D derivatives) should be avoided in flexural psoriasis. A mild steroid is appropriate.
When different preparations are used together, maximum total calcipotriol 5mg in any one week (e.g. scalp solution 60ml with cream/ointment 30g or cream/ointment 60g with scalp solution 30ml)
Calcipotriol 50 micrograms/g / betamethasone dipropionate 0.05%
- Gel (£37.21 = 60g, £69.11 = 2 x 60g)
- Gel applicator (£37.21 = 60g, £69.11 = 2 x 60g)
- Ointment (£39.68 = 60g, £73.86 = 120g)
- Foam (£39.68 = 60g)
- The recommended treatment period for foam and ointment is 4 weeks.
- The recommended treatment period for gel is 4 weeks for scalp areas and 8 weeks for non-scalp areas.
- If it is necessary to continue or restart treatment after this period, treatment should be continued after medical review and under regular medical supervision.
- When using calcipotriol containing medicinal products, the maximum daily dose of all calcipotriol containing products should not exceed 15g.
- The total body surface area treated with calcipotriol containing medicinal products should not exceed 30%.
- 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.
- Usually an amount between 1g and 4g of gel per day is sufficient for treatment of the scalp (4g corresponds to one teaspoon).
- Dovonex® ointment 50 micrograms/g (£24.04 = 120g)
- Scalp solution 50 micrograms/ml (£56.55 = 60ml)
- Apply ointment once or twice daily (adult); maximum 100g weekly (see notes above)
- Scalp psoriasis, apply scalp solution twice daily; maximum 60ml weekly (see notes above)
- Mild to moderate plaque psoriasis
- Apply twice daily; not more than 35% of body surface to be treated daily, maximum 30g daily
- Calcitriol should be used for those patients not responding to calcipotriol, or where application is on the face or flexure. Calcitriol can be applied to the face with caution, as there is an increased risk of irritation on this area. There is limited clinical experience for the use of calcitriol prescribed for more than 6 weeks.
- Shampoo (coal tar 1%, coconut oil 1%, salicylic acid 0.5%) (£4.69 = 250ml)
- For scaly scalp disorders including psoriasis, seborrheic dermatitis, dandruff and cradle cap, apply daily as necessary.
- Lotion, coal tar solution 5% (£8.11 = 100ml)
- Apply to skin or scalp 2–3 times daily; lotion can be diluted with a few drops of water before applying
- Cream, coal tar 6% (£9.42 = 225ml)
- Apply to skin or scalp 1–2 times daily
- Scalp ointment, coal tar solution 12%, salicylic acid 2%, precipitated sulphur 4% (£11.11 = 100g)
- Apply to scalp as necessary (if severe use daily for first 3-7 days), shampoo off after 1 hour (adult)
Alphosyl 2 in 1®
- Shampoo (alcoholic coal tar extract 5%) (£4.52 = 250ml)
- Psoriasis, seborrhoeic dermatitis, scaling and itching, use every 2–3 days
- Shampoo (coal tar extract 2%) (£5.38 = 250ml)
- Scalp psoriasis, seborrhoeic dermatitis, dandruff, apply 2–3 times weekly
- Scalp ointment (£11.69 = 100g)
- Scaly scalp disorders including psoriasis
- Rub into scalp once weekly as necessary (if severe use daily for first 3–7 days), after 1-2 hours comb out to remove loose scales, shampoo off using Capasal® shampoo)
Tar with corticosteroid (unlicensed preparations)
25% betamethasone ointment and coal tar paste
- (Equal Parts) Coal tar solution 5% in betamethsone valerate 0.025% in ointment
Tar pomade scalp - cade oil pomade
Coal tar in emulsifying ointment
- 7.5%, 12.5%, 25%, 35%, 40%, 45% - 100g
Coal tar in yellow soft paraffin
Coal tar paste
- Dithrocream® cream 0.1% to 2% (£3.77 to £5.77 = 50g)
- Application to skin or scalp; 0.1–0.5% cream suitable for overnight treatment, 1–2% cream for maximum 1 hour
- Micanol® cream 1% (£16.18 = 50g)
- Micanol® cream 3% (£20.15 = 50g)
- Application to skin or scalp, apply 1% cream for up to 30 minutes once daily, if necessary 3% cream can be used under medical supervision
- At the end of contact time, use plenty of lukewarm (not hot) water to rinse off cream; soap may be used after the cream has been rinsed off; use shampoo before applying cream to scalp and if necessary after cream has been rinsed off
British Association of Dermatologists accepted unlicensed dithranol preparations (extemporaneously prepared)
Dithranol 0.1% - 20%
- in emulsifying ointment with salicylic acid 2%
- in Lassar's paste
Oral preparations for psoriasis
- The risk of foetal malformation with oral retinoids is extremely high, even when used at a low dose or for a short time during pregnancy. All oral retinoids have an associated 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 considerably longer.
- For further details, refer to the BNF, MHRA drug safety update (June 2013), and the manufacturer's summary of product characteristics.
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13.5.2 Preparations for psoriasis
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