Psoriasis

L40.0-5/L40.8-9

DESCRIPTION

This is an inflammatory condition of the skin and joints of unknown aetiology. Scaly red, papules and plaques over extensor surfaces and on the scalp are common. The nails and skin folds are often involved. In exceptional cases, it is localised to palms and soles and pustular skin lesions are seen, especially following rapid treatment withdrawal, e.g. steroids or systemic agents.

GENERAL MEASURES

Counselling regarding precipitating factors and chronicity.
Encourage sun exposure as tolerated.

MEDICINE TREATMENT

Note:

  • Systemic steroids should be avoided.
  • Patient adherence is the greatest barrier to treatment success with topical therapies.

Local plaques

For maintenance:

  • Coal tar 6% ointment, topical, apply at night.
    • Avoid use on the face, flexures and genitalia.

For flares:

LoEIII [11]

  • Potent topical corticosteroids, e.g.:
    • Betamethasone 0.1%, topical, apply 12 hourly.
      • Decrease according to severity, reduce to hydrocortisone 1%, then stop.

Scalp psoriasis

For maintenance:

  • Wash with coal tar containing shampoo.

OR

  • Coal tar 1% ointment, topical, apply at night, under occlusion and wash out the next morning.

For flares:

LoEIII [12]

  • Potent topical corticosteroids, e.g.:
    • Betamethasone 0.1% lotion, topical, apply once daily.

REFERRAL

  • Indequate response to topical treatment.
  • Severe disease, especially if joint involvement.