Corticosteroid-containing products
Coal tar products (3rd line agents)
Prescribing Notes
- Offer a potent corticosteroid applied once daily for up to 4 weeks as initial treatment for people with scalp psoriasis. Refer to NICE CG153 for further details on treatment recommendations
- Salicylic acid 2% may enhance loss of scale
- 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.
- Do not offer coal tar-based shampoos alone for the treatment of severe scalp psoriasis
- Cocois® ointment is a licensed alternative to coal tar pomade
- 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
- Topical vitamin D preparations alone can be used where corticosteroids are not tolerated, or if there is mild-moderate scalp psoriasis