Corticosteroid-containing products (first line)
| Choice | Drug | Dosage |
|---|---|---|
| 1st choice | Potent topical corticosteroid | |
| Betametasone valerate 0.1%: scalp application (Betnovate®) | Dose: Apply night and morning until improvement, then reduce frequency as per product directions | |
| Or | ||
| Fluocinolone acetonide 0.025% (Synalar®) gel | Dose: Apply once daily | |
| 2nd choice Combination products | Corticosteroid /Salicylic acid (for scaling) | |
| Diprosalic® scalp application | Dose: Apply once to twice daily | |
| Or | ||
| Corticosteroid / vitamin D analogue | ||
| Dovobet® gel (Calcipotriol 50microgram/g, betamethasone 500microgram/g) | Dose: Apply once daily |
Coal tar products (Second line )
| Choice | Drug | Dosage |
|---|---|---|
| Formulary choices | Exorex® lotion (100mls/ 250mls) (coal tar 5% in an emollient basis) | Dose: Apply 2-3 times a day |
Coal tar /Salicylic acid (for scaling) |
| |
| and / or | ||
| Shampoos | See section 13.9 |
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.
- Coal tar preparations are effective but may stain skin, hair and clothes. Do not offer coal tar based shampoos alone for the treatment of severe scalp psoriasis.
- Salicylic acid 2% may enhance loss of scale.
- Sebco® scalp 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. The conventional proportions are:
- coal tar solution 6%, salicylic acid 2%, emulsifying ointment to 100g; pack size is 200g
- coal tar solution 10%, salicylic acid 6%, emulsifying ointment to 100g; pack size is 200g