220.127.116.11 Trunk and Limbs
Topical preparations for Chronic Plaque Psoriasis
Trunk and limbs
Vitamin D and analogues
Calcipotriol 50 micrograms/g
Plus potent topical steroid applied separately (see section 13.4)
product (where adherence is an issue)
Calcipotriol 50microgram/g, betamethasone 500microgram/g ointment
(for when ointment not tolerated)
Enstilar® foam (calcipotriol 50micrograms/g, betamethasone 500microgram/g)
Coal tar products (2nd line agents)
- Dual therapy of a potent topical corticosteroid plus a topical vitamin D preparation is first line (both applied once a day, but one in the morning and the other in the evening) for up to 4 weeks as initial treatment. See NICE CG153 for further details on treatment recommendations.
- Aim for a break of 4 weeks between steroid treatment courses. Consider non-steroid based topical treatments (such as vitamin D or coal tar) as needed to maintain control during this period.
- A combination product (calcipotriol 50microgram/g and betamethasone 500microgram/g) can be used where adherence is an issue. Enstilar® (calcipotriol and betamethasone cutaneous foam) is an alternative where calcipotriol 50microgram/g and betamethasone 500microgram/g ointment is not tolerated
- Coal tar preparations are effective but may stain skin, hair and clothes. Newer, branded products are preferred because the older non-branded products contain crude coal tar (coal tar BP) which is smellier and usually messier to use.
- If tar pomade (an unlicensed product) is being prescribed, it should be prescribed in “conventional proportions” which are significantly less expensive than bespoke mixtures ordered from “specials” manufacturers. Given the wide variety in price community pharmacies are encouraged to order from a cost effective supplier such as Victoria Pharmaceuticals via Movianto. The “conventional” proportions are:
- coal tar solution 6%, salicylic acid 2%, emulsifying ointment to 100g; pack size is 200g