Treatment in Primary Care

Patients can be treated initially with first line therapies:

	Topical vitamin D analogues such as Calcipotriol (Dovonex) or Talcacitol (Curatoderm)			Topical Steroids – scalp, flexures and face (see BNF Section 13.5)
				Tar Preparations

 

• Please do not commence on oral steroids. This may be dangerous in erythrodermic psoriasis and generalised pustular psoriasis, and always makes subsequent management of psoriasis more difficult.
• Treatments should be reviewed at around 1-2 months. It is important to assess whether the products have been correctly applied.
• Patients with severe psoriasis that is likely to require second line therapy should be referred and commenced on a first line treatment whilst awaiting their appointment.

Specialist services

These are in a position to:

• confirm or establish the diagnosis
• provide inpatient care
• provide, in conjunction with other healthcare professionals, advice on the condition and its treatment, together with social and psychological support
• assess and supervise the use of phototherapy and PUVA, as well as oral retinoids, cytotoxic therapy and immunosuppressive therapy
• treat psoriasis that is unresponsive to therapies tried in primary care, or to resolve problems where the patient cannot tolerate the treatment
• offer acute treatment in patients with severe conditions such as erythrodermic psoriasis or generalised pustular psoriasis
• provide and support specialist nursing services working in primary and secondary care
• provide assessment and advice for patients with painful psoriatic arthropathy

 

Referral Advice

Most patients with psoriasis can be managed in primary care. Referral to specialist services, which may be prompted by features such as sleep disturbance, social exclusion, reduced quality of life or reduced self-esteem, is advised if:

	The patient has generalised pustular or erythrodermic psoriasis
	The patient’s psoriasis is acutely unstable
	The patient has widespread guttate psoriasis (so that he/she can benefit from early phototherapy)
	The condition is causing severe social or psychological problems
	The rash is sufficiently extensive to make self-management impractical
	The rash is in a sensitive area (such as face, hands, feet, genitalia) and the symptoms particularly troublesome
	The patient requires assessment for the management of associated arthropathy
	The rash fails to respond to management in general practice.  Failure is probably best based on the subjective assessment of the patient. i.e. sometimes it occurs when patients are unable to apply the treatment themselves.

 

Immediate

Urgent

Soon

Routine

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