9 Management- Plaques Depends on amount of body surface affected. Consider psychological impact and discussEmollientTopical vitamin d analogue +/- moderately potent topical steroid short term.Caution regarding DovobetExorex for small multiple plaquesreview
10 Plaque continuedDithranol an option if motivated and able to apply correctlyLimited response- consider UVBSystemic therapy- Methotrexate / NeotigasonBiological agents
11 Guttate psoriasis May occur after a streptococcal throat infection Often resolves after a few weeksTopical tar e.g. ExorexMild topical steroidConsider referral for UVB if not improving
12 Flexural Psoriasis Often treated as thrush- look for clues Milder vitamin d analogue( tacalcitol / calcitriol). Topical steroid ( clobetasone butyrate)Reduce frequency when settled to maintain control
13 Scalp psoriasis Challenging and requires dedication Psoriasis association advice sheet explains how to apply treatments.Mild - tar based shampoo used twice a weekModerate - above+ calcipotriol or betamethasone scalp application 2-3 times a weekSevere – salicylic acid/ coal tar applied and left on overnight, comb out, wash then apply steroid/ vitamin d application.
14 Scalp cont’dMaintain with 1-2 x a week vitamin d analogue or weakest topical steroid that will control + tar based shampoo.
15 Nail psoriasis Exclude fungal infection- clippings Nothing works topically.Nail varnish for women
16 Hands and feet Can be a challenge. Emollient – thicker and possibly urea basedSalicylic acid to soften scalePotent topical steroid – ointment/ occlusionVitamin d analogues bit impractical as need to apply a thick layerRefer for PUVA and possibly systemic treatment