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13.5 Preparations for eczema and psoriasis Toggle Pages
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13.5.2 Preparations for psoriasis

First Line
Second Line
Specialist
Hospital Only

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

  1. Treatment may be continued beyond 4 weeks or repeated, on the advice of a specialist
  2. 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 or Foam: Apply once daily for 4 weeks

Notes

  1. Treatment may be continued beyond 4 weeks or repeated, on the advice of a specialist
  2. Apply to a maximum 30% of body surface
  3. Maximum total calcipotriol 5mg in any one week
  4. 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
  5. Calcipotriol monohydrate / betamethasone dipropionate foam is contraindicated in generalised pustular psoriasis
Calcitriol

(3micrograms/g)

  • Ointment (£18.06 = 100g)

Indications

Dose

  • Apply once or twice daily for 4 weeks, maximum 30g daily

Notes

  1. Calcitriol should be used for those patients not responding to calcipotriol
  2. Not more than 35% of body surface to be treated daily

Tars

Psoriderm scalp lotion

(Coal tar distilled 25mg/ml)

  • Scalp lotion (£4.74 = 250ml)

Indications

Dose

  • Apply to scalp as required to remove adherent scale

Notes

  1. Useful in softening thick adherent scale on the surface of the psoriasis plaques
Exorex lotion

(Coal tar solution50mg/g)

  • Cutaneous emulsion (£8.11 = 100ml, £16.24 = 250ml)

Indications

Dose

  • Apply to skin or scalp 2–3 times daily

Notes

  1. Useful in softening thick adherent scale on the surface of the psoriasis plaques
  2. Lotion can be diluted with a few drops of water before applying
Tar with lecithin
Psoriderm cream

(Coal tar distilled 60mg/g / Lecithin 4mg/g)

  • Cream (£9.42 = 225ml)

Indications

Dose

  • Apply to skin or scalp once or twice daily

Notes

  1. 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)

  • Ointment (£15.88 = 100g)

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

  1. 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)

  • Ointment (£14.50 = 100g)

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

  1. Useful in softening thick adherent scale on the surface of the psoriasis plaques

Oral preparations for psoriasis

Oral systemic non-biological agents for psoriasis management, listed elsewhere in the formulary:

Oral retinoids for psoriasis

Acitretin
  • Capsules 10mg, 25mg

Notes

  1. 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.
  2. 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)
  3. 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
  4. 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
  5. 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
  6. 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
    1. See also resources for: contraception for drugs with teratogenic potential, and prescribing in pregnancy and lactation
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