Treatment

Management of plaque psoriasis may include the option of no active treatment depending on the requirements of the patients (1). Some patients may settle for emollients only if they are not desperate to clear the skin completely.

In instances where patients require active treatment coal tar, dithranol, corticosteroids (should be restricted to use on the scalp, face and flexures) and vitamin D analogues (Calcipotriol) are usually effective topical agents

• when numerous, small plaques - options include vitamin D analogues, mild tar preparations and corticosteroid topical treatments
• when the plaques are larger and less frequent - options include dithranol (may be administered as a short contact therapy - administered for 30 minutes and then washed off once a day), tar or vitamin D analogues (1)

Patient response varies and any of the above topical agents may prove successful and the treatment outcome can be enhanced by UVB therapy (1).Topical therapy should be explored fully before progressing to second line therapy which should be performed by a dermatologist.

Options include:

• PUVA - usually, the systemic treatment of first choice
• UVB or narrow band UVB alone (2) or in combination with tar or dithranol
• systemic treatment - methrotrexate, etretinate or cyclosporin - all are contraindicated in pregnancy and require close monitoring; methrotrexate may cause sperm abnormalities; etretinate and cyclosporin are expensive

Reference:

• 1. The British Association of Dermatologists 2006. General management of Psoriasis -Specific sites.
• 2. The British Association of Dermatologists 2006. General management of Psoriasis -Phototherapy