| Therapeutic Area | Formulary Choices | Cost for 28 (unless otherwise stated) | Rationale for decision / comments |
|---|---|---|---|
| 13.5.2 Preparations for psoriasis | |||
| For the topical treatment of psoriasis affecting the trunk and limbs NICE recommends: potent corticosteroid applied once daily plus vitamin D or a vitamin D analogue applied once daily (applied separately, one in the morning and the other in the evening) for up to 4 weeks as initial treatment for adults. For the topical treatment of psoriasis affecting the scalp: a potent corticosteroid applied once daily for up to 4 weeks as initial treatment for adults. Choice of formulation: - cream, lotion or gel for widespread psoriasis - lotion, solution or gel for the scalp or hair-bearing areas - ointment to treat areas with thick adherent scale Aim for a break of 4 weeks between courses of treatment with potent or very potent corticosteroids. Do not use very potent corticosteroids continuously at any site for longer than 4 weeks. Do not use potent corticosteroids continuously at any site for longer than 8 weeks. Regular emollient use may be considered to reduce fall of scales and help with other symptoms, including itch. |
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| Vitamin D analogues | |||
| Ointments | |||
| First-line 1st option | Calcitriol 0.0003% (Silkis®) | Ointment: £18.06 (100g) | Mild to moderately severe plaque psoriasis (psoriasis vulgaris) with up to 35% of body surface area involvement. Recommended courses of up to 6 weeks. |
| 2nd option | Calcipotriol 50mcg/g (Dovonex®) | Ointment: £5.78 (30g) | Ointment: Plaque psoriasis (psoriasis vulgaris) amenable to topical therapy. Recommended courses of up to 6 weeks. |
| Second-line | Tacalcitol 0.0004% (Curatoderm®) | Ointment: £13.40 (30g) £30.86 (100g) | Ointment: Psoriasis vulgaris Recommended courses of up to 8 weeks. |
| Third-line | Calcipotriol 50mcg/g, betamethasone 0.5mg/g as (Dalonev®) (Dovobet®) | Ointment: £15.82 (30g) £31.69 (60g) £59.04 (120g) Ointment: £19.84 (30g) £39.68 (60g) £73.86 (120g) | Ointment: Stable plaque psoriasis vulgaris amenable to topical therapy in adults. Dalonev is 20% lower than the Drug Tariff reimbursement price of Calcipotriol 0.005% / Betamethasone dipropionate 0.05% ointment. |
| Gels/Lotions/Solutions | |||
| First-line | Tacalcitol 0.0004% (Curatoderm®) | Lotion: £12.73 (30ml) | Lotion: Psoriasis vulgaris, especially on the scalp |
| Second-line | Calcipotriol 50mcg/g, betamethasone 0.5mg/g (Dovobet®) Calcipotriol 50mcg/g, betamethasone 0.5mg/g Enstilar® | Gel: £37.21 (60g) £69.11 (120g) Cutaneous Foam: £39.68 (60g) | Gel: Topical treatment of scalp psoriasis in adults. Topical treatment of mild to moderate 'non-scalp' plaque psoriasis vulgaris in adults. The gel is licensed for body and scalp application. UK market research indicates the majority of patients prefer a gel formulation. Recommended course of up to 4 weeks for scalp areas and up to 8 weeks for 'non scalp' areas Recommended course is 4 weeks in all body areas |
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| Tazarotene | Tazarotene 0.05% (Zorac®) Tazarotene 0.1% (Zorac®) | Gel 0.05%: £14.09 (30g) Gel 0.1%: £14.80 (30g) | Topical treatment of mild to moderate plaque psoriasis involving up to 10% body surface area. Recommended treatment period of up to 12 weeks. |
| Coal Tar Preparations | |||
| First-line | Psoriderm® Emulsion 40% Bath Additive | Bath Emulsion: £2.74 (200ml) | Distilled coal tar 40.0% w/v Sub-acute and chronic psoriasis |
| Second-line 1st option | Coal tar extract 5% shampoo (Alphosyl® 2 in 1) | Shampoo: £4.52 (250ml) | Alcoholic extract of coal tar 5% w/w Treatment of scalp disorders including: psoriasis; seborrhoeic dermatitis; eczema; pruritus and scalp associated with psoriasis, seborrhoeic dermatitis and eczema; itchy, oily scalp; dandruff. The normal duration of use is 4 weeks. |
| 2nd option | Coal tar extract 2% shampoo (Neutrogena T-Gel®) | Shampoo: £3.61 (125ml) £5.38 (250ml) | Neutar solubilised coal tar extract 2% (equivalent to 0.5%coal tar) Scalp psoriasis. Recommended treatment period of up to 6 weeks. |
| Salicylic acid preparations | |||
| Salicylic Acid BP 2% | Ointment: £8.08 (450g) | ||
| Dithranol | |||
| Dithrocream® | Cream: 0.1% £3.77 (50g) 0.25% £4.04 (50g) 0.5% £4.66 (50g) 1% £5.42 (50g) 2% £5.77 (50g) | White soft paraffin,cetostearyl alcohol, salicylic acid, ascorbic acid, sodium laurilsulfate, chlorocresol and purified water. Dithrocream 2% w/w also contains liquid paraffin. Recommended course of 4 to 6 weeks. |
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| Combination preparations | |||
| First-line 1st option | Capasal® | Shampoo: £4.69 (250ml) | Coal tar 1%, coconut oil 1%, salicylic acid 1% Also contains: lauric acid diethanolamide, coco amido propyl dimethyl betaine, triethanolamine lauryl sulfate (trolamine lauril sulfate), phenoxyethanol, ammonium sulfate, water purified |
| 2nd options | Psoriderm® Scalp Lotion Shampoo | Scalp Lotion Shampoo: £4.74 (250ml) | Scalp Lotion Shampoo: Distilled Coal Tar 2.5% w/v; Lecithin 0.3% w/v Sub-acute and chronic psoriasis Also contains: triethanolamine lauryl sulfate (trolamine lauril sulfate), lauric acid diethanolamide, disodium edetate, sodium chloride, phenoxyethanol, ammonium sulfate, water purified |
| Psoriderm® Cream | Cream: £9.42 (225ml) | Cream: Distilled Coal Tar 6.0% w/w; Lecithin 0.4% w/w Sub-acute and chronic psoriasis Also contains: stearic acid, isopropyl palmitate, propylene glycol, trolamine, phenoxyethanol, purified water |
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| Second-line | Sebco® | Ointment: £5.91 (40g) £11.11 (100g) | Coal tar 12%, sulfur 4%, salicylic acid 2% in coconut oil, also contains: white soft paraffin, cetostearyl alcohol, glycerol, liquid paraffin, polyoxyethylene glycerol monostearate, hard paraffin |
| Cocois® | Ointment: £6.22 (40g) £11.69 (100g) | Coal tar 12%, sulfur 4%, salicylic acid 2% in coconut oil, also contains: white soft paraffin, cetostearyl alcohol, glycerol, liquid paraffin, polyoxyethylene glycerol monostearate, hard paraffin | |
| Diprosalic® (Betamethasone Dipropionate 0.05% + Salicylic Acid 3%) | Ointment: £3.18 (30g) £9.14 (100g) Scalp application: £10.10 (100ml) | Recommended prescribing for 2 weeks, and that treatment is reviewed at that time. Contains a potent corticosteroid. |
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