Therapeutic AreaFormulary ChoicesCost for 28
(unless otherwise stated)
Rationale for decision / comments
13.5.2 Preparations for psoriasis
For the topical treatment of psoriasis affecting the trunk and limbs NICE recommends: potent corticosteroid applied once daily plus vitamin D or a vitamin D analogue applied once daily (applied separately, one in the morning and the other in the evening) for up to 4 weeks as initial treatment for adults. For the topical treatment of psoriasis affecting the scalp: a potent corticosteroid applied once daily for up to 4 weeks as initial treatment for adults.
Choice of formulation:
- cream, lotion or gel for widespread psoriasis
- lotion, solution or gel for the scalp or hair-bearing areas
- ointment to treat areas with thick adherent scale
Aim for a break of 4 weeks between courses of treatment with potent or very potent corticosteroids. Do not use very potent corticosteroids continuously at any site for longer than 4 weeks. Do not use potent corticosteroids continuously at any site for longer than 8 weeks.
Regular emollient use may be considered to reduce fall of scales and help with other symptoms, including itch.
Vitamin D analogues
Ointments
First-line
1st option
Calcitriol 0.0003%
(Silkis®)
Ointment: £18.06 (100g)Mild to moderately severe plaque psoriasis (psoriasis vulgaris) with up to 35% of body surface area involvement.
Recommended courses of up to 6 weeks.
2nd optionCalcipotriol 50mcg/g
(Dovonex®)
Ointment: £5.78 (30g)Ointment: Plaque psoriasis (psoriasis vulgaris) amenable to topical therapy.

Recommended courses of up to 6 weeks.
Second-lineTacalcitol 0.0004%
(Curatoderm®)
Ointment: £13.40 (30g)
£23.14 (60g)
£30.86 (100g)
Ointment: Psoriasis vulgaris

Recommended courses of up to 8 weeks.
Third-lineCalcipotriol 50mcg/g, betamethasone 0.5mg/g
(Dovobet®)
Ointment: £19.84 (30g)
£39.68 (60g)
£73.86 (120g)
Ointment: Stable plaque psoriasis vulgaris amenable to topical therapy in adults.

Gels/Lotions/Solutions
First-lineTacalcitol 0.0004%
(Curatoderm®)
Lotion: £12.73 (30ml)Lotion: Psoriasis vulgaris, especially on the scalp
Second-lineCalcipotriol 50mcg/g, betamethasone 0.5mg/g
(Dovobet®)


Calcipotriol 50mcg/g, betamethasone 0.5mg/g
Enstilar®
Gel: £37.21 (60g)
£69.11 (120g)




Cutaneous Foam: £39.68 (60g)
Gel: Topical treatment of scalp psoriasis in adults. Topical treatment of mild to moderate 'non-scalp' plaque psoriasis vulgaris in adults.
The gel is licensed for body and scalp application. UK market research indicates the majority of patients prefer a gel formulation.
Recommended course of up to 4 weeks for scalp areas and up to 8 weeks for 'non scalp' areas

Recommended course is 4 weeks in all body areas
Dovobet
TazaroteneTazarotene 0.05%
(Zorac®)

Tazarotene 0.1%
(Zorac®)
Gel 0.05%: £14.09 (30g)


Gel 0.1%: £14.80 (30g)
Topical treatment of mild to moderate plaque psoriasis involving up to 10% body surface area.
Recommended treatment period of up to 12 weeks.
Coal Tar Preparations
First-linePsoriderm® Emulsion 40% Bath AdditiveBath Emulsion:
£2.74 (200ml)
Distilled coal tar 40.0% w/v
Sub-acute and chronic psoriasis
Second-line
1st option
Coal tar extract 5% shampoo
(Alphosyl® 2 in 1)
Shampoo: £4.52 (250ml)Alcoholic extract of coal tar 5% w/w
Treatment of scalp disorders including: psoriasis; seborrhoeic dermatitis; eczema; pruritus and scalp associated with psoriasis, seborrhoeic dermatitis and eczema; itchy, oily scalp; dandruff.
The normal duration of use is 4 weeks.
2nd optionCoal tar extract 2% shampoo
(Neutrogena T-Gel®)
Shampoo: £3.61 (125ml)
£5.38 (250ml)
Neutar solubilised coal tar extract 2% (equivalent to 0.5%coal tar)
Scalp psoriasis.
Recommended treatment period of up to 6 weeks.
Salicylic acid preparations
Salicylic Acid BP 2%Ointment: £8.08 (450g)
Dithranol
Dithrocream®Cream: 0.1% £3.77 (50g)
0.25% £4.04 (50g)
0.5% £4.66 (50g)
1% £5.42 (50g)
2% £5.77 (50g)
White soft paraffin,cetostearyl alcohol, salicylic acid, ascorbic acid,
sodium laurilsulfate, chlorocresol and purified water. Dithrocream 2% w/w also contains liquid paraffin.

Recommended course of 4 to 6 weeks.
Combination preparations
First-line
1st option
Capasal®Shampoo: £4.69 (250ml)Coal tar 1%, coconut oil 1%, salicylic acid 1%

Also contains: lauric acid diethanolamide, coco amido propyl dimethyl betaine, triethanolamine lauryl sulfate (trolamine lauril sulfate), phenoxyethanol, ammonium sulfate, water purified
2nd optionsPsoriderm® Scalp Lotion ShampooScalp Lotion Shampoo:
£4.74 (250ml)
Scalp Lotion Shampoo: Distilled Coal Tar 2.5% w/v; Lecithin 0.3% w/v
Sub-acute and chronic psoriasis

Also contains: triethanolamine lauryl sulfate (trolamine lauril sulfate), lauric acid diethanolamide, disodium edetate, sodium chloride, phenoxyethanol, ammonium sulfate, water purified
Psoriderm® CreamCream: £9.42 (225ml)Cream: Distilled Coal Tar 6.0% w/w; Lecithin 0.4% w/w
Sub-acute and chronic psoriasis

Also contains: stearic acid, isopropyl palmitate, propylene glycol, trolamine, phenoxyethanol, purified water
Second-line
1st option
Meted®Shampoo: £3.80 (120ml)Salicylic acid 3%, sulphur 5%

Also contains: magnesium aluminium silicate, hypromellose, panthenol, sodium laureth sulphate, sodium cocoyl sarcosinate, cocamido propyl betaine, fragrance - 430 015, purified water
2nd optionsSebco® Ointment: £5.91 (40g)
£11.11 (100g)
Coal tar 12%, sulfur 4%, salicylic acid 2% in coconut oil, also contains: white soft paraffin, cetostearyl alcohol, glycerol, liquid paraffin, polyoxyethylene glycerol monostearate, hard paraffin
Cocois®Ointment: £6.22 (40g)
£11.69 (100g)
Coal tar 12%, sulfur 4%, salicylic acid 2% in coconut oil, also contains: white soft paraffin, cetostearyl alcohol, glycerol, liquid paraffin, polyoxyethylene glycerol monostearate, hard paraffin
Diprosalic® (Betamethasone Dipropionate 0.05% + Salicylic Acid 3%)Ointment: £3.18 (30g)
£9.14 (100g)
Scalp application:
£10.10 (100ml)
Recommended prescribing for 2 weeks, and that treatment is reviewed at that time.
Contains a potent corticosteroid.