MTW NHS Trust West Kent CCG

Drug Status Key

  • Preferred
  • Second Line
  • Third Line
  • Specialist Initiation
  • Hospital Only
  • Not Approved for Formulary

Eczema, Psoriasis and other skin conditions

Drug Safety Update

September 2021: Topical corticosteroids: information on the risk of topical steroid withdrawal reactions

NICE Guidance

 CG153: Psoriasis: assessment and management, updated September 2017

There is no cure for psoriasis, although there are effective treatments.

Treatment is suppressive, aimed at inducing a remission or making the amount of psoriasis tolerable to the patient.

For the majority of patients, the disease follows a chronic course, interspersed with periods of remission. Relapses are difficult to predict and cannot be prevented with topical therapy.

Treatment choice depends on site, type and severity of psoriasis and patient preference and tolerance.

First line treatments include emollients, keratolytics, coal tar preparations and weak corticosteroids.

Emollients should be used as frequently as needed and in addition use soap substitutes and bath additives. Emollients as well as their effects on dryness, scaling and cracking, may have an antiproliferative effect in psorisis.

Topical steroids, (mild to moderate), can be very useful for limited psoriasis or flexural psoriasis. The weaker steroids often do not work very well on thick patches, but may work better on the face or in the skin folds. Potent and very potent topical corticosteroids should be used on specialist advice only; they may precipitate unstable and pustular psoriasis after stopping.

Coal tar preparations are effective but may stain skin, hair and clothes.

Dithranol is effective for chronic plaque psoriasis. It is an irritant and stains both clothing and skin. Care should be taken to avoid normal skin as it can cause temporary burning. It is usually prescribed as a short-term regime and treatment should be started at low concentrations and gradually increased. Most preparations should only be used for short contact periods of 30-60 minutes.

Calcipotriol is an analogue of vitamin D that affects cell division and differentiation, but has little effect on calcium metabolism. It is more effective than the alternatives, other than for guttate psoriasis when vitamin D derivatives are generally less effective. Total maximum calcipotriol 5mg (100g of calcipotriol preparations) in any one week.

Combination of calcipotriol and steroids - combining the use of corticosteroid with calcipotriol may be beneficial in chronic plaque psoriasis. The drugs may be used separately at different times of the day or used together in a single formulation.

Salicylic acid 2% or 3% may enhance loss of scale.

Eczema co-existing with psoriasis may be treated with a corticosteroid or coal tar, or both.