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 Prescribing information section on Vitamin D preparations for more information. Advice should be given on how to minimize the risk of corticosteroid adverse effects, such as stopping the topical corticosteroid once the skin is clear or nearly clear. Sources of information include the Psoriasis Association leaflets on Topical steroids and Vitamin D ¹.
• Consider a salicylic acid preparation if scale is problematic. See the Prescribing information section on Salicylic acid 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, or if the psoriasis is at least moderately severe as measured by the Physician's Global Assessment ¹.
• If there is uncertainty about the diagnosis, or if psoriasis is resistant to topical drug treatments or treatments are not tolerated ¹.
• If there is a significant impact on the person's physical, psychological, or social wellbeing ¹.
• If the person has suspected psoriatic arthritis, or if there are new joint symptoms, an urgent referral to a rheumatologist should be arranged ¹.