Treatment Plan

Treatment Plan

General advice:

• Lifestyle advice: stop smoking & alcohol, weight loss
• Manage stresses and mental health.
• Various topical treatments are available:
  • Emollients o topical cortical steroids o        Vitamin D analogues o           Coal Tar
  • Short contact Dithranol (used in extensive plaque psoriasis) Trunk/Limb Psoriasis:
• First-line: Potent topical corticosteroids (betamethasone 0.1%) + vitamin D analogue

(calcipotriol/calcitriol) o         Used separately once daily o           Review at 4 weeks

o    Continue to 8 weeks if responding o Break from steroids after 8 weeks

• Vitamin D can continue for 12 weeks
• Alternative (if still poor response at 8 to 12 weeks):

o    Potent topical corticosteroid or Coal tar for four weeks o      Dovobet (combination) once daily for 4 weeks o         Dithranol  Scalp Psoriasis:

• Potent topical corticosteroids (4 weeks) o If poor response:
• Try different formulations of steroids, E.g., shampoo, + consider pretreatment: emollients, salicylic acid, olive oils
• If still unresponsive, add vitamin D analogue to the steroid (4 weeks)

If still unresponsive: very potent corticosteroid (2 weeks) OR coal tar OR referral

If topical corticosteroids cannot be used: vitamin D/vitamin D analogues (8 weeks) OR Coal tar OR specialist input Facial/Flexural/Guttate:

• Mild-moderate potent corticosteroids short-term Referral Criteria:
• Uncertain diagnosis
• >10% body surface area
• Moderate-severe disease
• Severe nail involvement
• Cosmetic concerns
• Psoriatic arthritis
• Emergency referral for erythrodermic/generalised pustular forms