13.5.2.1 Scalp

Corticosteroid-containing products (first line)

ChoiceDrugDosage
1st choicePotent 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 productsCorticosteroid /Salicylic acid (for scaling)
Diprosalic® scalp applicationDose:
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 )

ChoiceDrugDosage
Formulary choicesExorex® lotion (100mls/ 250mls) (coal tar 5% in an emollient basis)Dose: Apply 2-3 times a day

Coal tar /Salicylic acid (for scaling)
Sebco® scalp ointment (coal tar solution 12%, salicylic acid 2%, precipitated sulphur 4% in coconut oil emollient basis)


Dose:
Apply to scalp as necessary (if severe use daily for first 3-7 days), shampoo off after 1 hour

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