Management- Plaques Depends on amount of body surface affected. Consider psychological impact and discuss Emollient Topical vitamin d analogue +/- moderately potent topical steroid short term. Caution regarding Dovobet Exorex for small multiple plaques review
Plaque continued Dithranol an option if motivated and able to apply correctly Limited response- consider UVB Systemic therapy- Methotrexate / Neotigason Biological agents
Guttate psoriasis May occur after a streptococcal throat infection Often resolves after a few weeks Topical tar e.g. Exorex Mild topical steroid Consider referral for UVB if not improving
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
Scalp psoriasis Challenging and requires dedication Psoriasis association advice sheet explains how to apply treatments. Mild - tar based shampoo used twice a week Moderate - above+ calcipotriol or betamethasone scalp application 2-3 times a week Severe – salicylic acid/ coal tar applied and left on overnight, comb out, wash then apply steroid/ vitamin d application.
Scalp contd Maintain with 1-2 x a week vitamin d analogue or weakest topical steroid that will control + tar based shampoo.
Nail psoriasis Exclude fungal infection- clippings Nothing works topically. Nail varnish for women
Hands and feet Can be a challenge. Emollient – thicker and possibly urea based Salicylic acid to soften scale Potent topical steroid – ointment/ occlusion Vitamin d analogues bit impractical as need to apply a thick layer Refer for PUVA and possibly systemic treatment