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
|
 |
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. |
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 |
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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