Synopsis
Prescribe vitamin-D analogues and topical corticosteroids by psoriasis site and formulation, give usable quantities and stop points, prevent calcium and steroid toxicity, and review before repeating treatment.
- Topical treatment is first-line for most psoriasis, but the safest active ingredient, potency, formulation, frequency and duration are site-specific.
- For adult trunk or limb plaques, NICE initial treatment is a potent corticosteroid once daily plus vitamin-D analogue once daily, applied separately morning and evening, for up to four weeks.
- For scalp psoriasis, NICE starts a potent corticosteroid once daily for up to four weeks; check hair-parting, vehicle and scale before switching.
Key red flags
Widespread pustulation, erythroderma, fever, shivering or haemodynamic disturbance requires urgent specialist treatment rather than a larger topical prescription.
Atrophy, easy bruising, telangiectasia, striae, acneiform eruption, perioral dermatitis and rebound suggest excessive exposure; widespread or occluded use can suppress the hypothalamic-pituitary-adrenal axis.
Investigation priorities
Choose corticosteroid potency, vitamin-D formulation and quantity according to anatomy and plaque characteristics.
Management branches
Stable plaque psoriasis suitable for topical treatment away from face, flexures and genitals.
- Agree ointment, cream, gel or foam according to thickness, hair, daily routine and preference; demonstrate the exact plaques and quantity to treat.
- Apply a potent corticosteroid once daily plus vitamin-D analogue once daily at different times, morning and evening, for up to four weeks under NICE guidance.