Psoriasis Guidelines (NICE)

Question 1

When would you prescribe systemic or phototherapy alongside topical therapy first line?

Answer 1

Extensive disease (more than 10% of body)

Areas where topical therapy won’t work e.g. nail disease

Question 2

What is the initial topical treatment for trunk and limb psoriasis?

Answer 2

Potent corticosteroid and vitamin D/vitamin D analogue for 4 weeks
One in morning, other at night

Question 3

What is the maximum time to co-prescribe potent steroids and vitamin D analogue for trunk and limb psoriasis?

Answer 3

8 weeks

Question 4

Treatment option if patient not adequately treated with potent steroids and vitamin D analogue for trunk and limb psoriasis?

Answer 4

Vitamin D analogue alone twice daily

Question 5

What to do if twice daily vitamin D analogue not adequately treated trunk and limb psoriasis?

Answer 5

Potent corticosteroid twice daily
OR
Coal tar preparation once or twice daily

Question 6

When should very potent corticosteroids only be offered for trunk and limb psoriasis?

Answer 6

In specialist settings under careful supervision
When other topical treatment strategies have failed
For a maximum period of 4 weeks.

Question 7

What is a treatment option for trunk and limb psoriasis resistant to steroids, vit d analogues and coal tar?

Answer 7

Dithranol topical
Only in specialist settings

Question 8

What is a treatment option for trunk and limb psoriasis resistant to steroids, vit d analogues and coal tar?

Answer 8

Dithranol topical
Only in specialist settings

Question 9

What 2 topical preparations can be used for children with trunk and limb psoriasis and what ages can they be used from?

Answer 9

Calcipotriol (6 years and above)
Potent steroid (Over 1 year)

Question 10

First line topical treatment for scalp psoriasis?

Answer 10

Potent steroid for 4 weeks

Question 11

Second line topical treatment for scalp psoriasis?

Answer 11

Different formulation of potent steroid
OR
Topical agents to remove adherent scale (for example, agents containing salicylic acid, emollients and oils) before application of the potent corticosteroid

Question 12

Third line topical treatment for scalp psoriasis?

Answer 12

Combined calcipotriol monohydrate and betamethasone dipropionate up to 4 weeks

Vitamin D or a vitamin D analogue (only in those who cannot use steroids and with mild to moderate scalp psoriasis).

Question 13

Fourth line scalp psoriasis topical treatment

Answer 13

A very potent corticosteroid fpr 2 weeks for adults only
OR
coal tar
OR
referral to a specialist for additional support with topical applications and/or advice on other treatment options.

Question 14

First line face, flexural and genital psoriasis topical treatment

Answer 14

2 weeks mild to moderate topical steroid

Question 15

When should phototherapy be used in psoriasis?

Answer 15

When topical treatments have failed

Question 16

What type of phototherapy is used in standard psoriasis?

Answer 16

UVB

Question 17

What type of phototherapy is used to treat palmoplantar pustulosis?

Answer 17

PUVA

Question 18

When should systemic therapy for psoriasis be used?

Answer 18

It cannot be controlled with topical therapy AND
It has a significant impact on physical, psychological or social wellbeing
AND
1 or more of the following apply:
psoriasis is extensive (for example, more than 10% of body surface area affected or a PASI score of more than 10)
OR
psoriasis is localised and associated with significant functional impairment and/or high levels of distress (for example, severe nail disease or involvement at high-impact sites) OR
phototherapy has been ineffective, cannot be used or has resulted in rapid relapse

Question 19

First line systemic therapy for psoriasis?

Answer 19

Methotrexate

Question 20

When should ciclosporin be used first line as systemic therapy for psoriasis?

Answer 20

need rapid or short-term disease control (for example, a psoriasis flare)
OR
have palmoplantar pustulosis
OR
are considering conception (both men and women) and systemic therapy cannot be avoided.

Question 21

Second line systemic therapy in psoriasis

Answer 21

Ciclosporin (or methotrexate if ciclosporin tried first line)