General Notes
- Refer to NICE CG153 Psoriasis: assessment and management and to the BAD website for a range of patient information leaflets on psoriasis.
- Offer topical treatments, taking into account patient preference, cosmetic acceptability, practicalities of application to the site(s) and extent of psoriasis.
- Discuss the variety of formulations available and use:
- creams, lotion or gel for widespread psoriasis
- lotion, solution or gel for scalp or hair-bearing areas
- ointment to treat areas with thick adherent scale
- In people whose psoriasis has not responded satisfactorily to a topical treatment discuss:
- whether they have any difficulties with application, cosmetic acceptability or tolerability and offer an alternative formulation if appropriate
- other possible reasons for non-adherence
- Arrange a review appointment after starting a new topical treatment after 4 weeks in adults.
- Phototherapy is available in specialist centres under the supervision of a dermatologist. UVB radiation is usually effective for chronic stable psoriasis and for guttate psoriasis.
- Acitretin (Neotigason®), an oral retinoid (vitamin A derivate), is available as a RED list medication in Northern Ireland for psoriasis. It is to be prescribed and supplied solely within the secondary care environment.
Identification of co-morbidities
- Discuss risk factors for cardiovascular co-morbidities with people who have any type of psoriasis (and their families or carers where appropriate) and give lifestyle advice as appropriate.
- In patients with severe psoriasis, offer a cardiovascular risk assessment at presentation using a validated risk assessment tool. Repeat every 5 years (or more frequently if indicated).
- Psoriasis of any type, especially if severe, is a risk factor for venous thromboembolism in adults. This risk should be explained to adults with any type of psoriasis and advice offered on how to minimise and manage the risk in line with NICE NG89 Venous Thromboembolism: reducing the risk.