Primary care psoriasis management: topical options and when to refer

Topical treatment options for psoriasis management in primary care include:

• An emollient to reduce scale and help relieve itch. See the section on Emollients in Prescribing information for more information. Provide advice on sources of information such as the Psoriasis Association leaflet on Moisturisers or the Psoriasis and Psoriatic Arthritis Alliance leaflet on Emollients and Psoriasis ¹.
• A potent topical corticosteroid plus a topical vitamin D preparation (both applied once a day, but at different times of day). See the CKS topic on Corticosteroids - topical (skin), nose, and eyes and the Vitamin D preparations in Prescribing information for more information. Give advice on how to minimize the risk of corticosteroid adverse effects, such as stopping the topical corticosteroid once the skin is clear or nearly clear. Provide advice on sources of information such as the Psoriasis Association leaflets on Topical steroids and Vitamin D ¹.
• Consider a salicylic acid preparation if scale is problematic. See the section on Salicylic acid in Prescribing information for more information ¹.

Referral to specialist services should be considered under the following circumstances:

• If lesions are extensive, severe, or not responding to treatment ¹.
• If there is significant impact on physical, psychological, or social wellbeing ¹.
• If the psoriasis is resistant to topical drug treatments or treatments are not tolerated ¹.
• If a diagnosis of psoriatic arthritis is suspected, an urgent referral to a rheumatologist should be arranged ¹.