Consult NICE CG 153 - Psoriasis: Assessment and management of psoriasis
Summary: Management of Psoriasis - taken from NICE CG 153:
- First line – Topical therapy – e.g. corticosteroids, vitamin D, vitamin D analogues, dithranol and tar preparations
- Second line – broad- or narrow-band UVB light and psoralen plus UVA light (PUVA) and systemic non-biologics e.g. ciclosporin, methotrexate or acitretin
- Third line – systemic biologics; Anti-TNFs – adalimumab, etanercept and infliximab and mono-clonal antibody ustekinumab which targets IL-12 and IL-23.
Offer second and third line therapies if topical therapies unlikely to control psoriasis, such as extensive disease e.g. > 10% body surface area affected, or at least “moderate” on the static Physicians Global Assessment.
Calcipotriol and tacalcitol are analogues of vitamin D that affect cell division and differentiation. Calcitriol is an active form of vitamin D. Vitamin D and its analogues are used first-line for the long-term treatment of plaque psoriasis; they do not smell or stain and they may be more acceptable than tar or dithranol products. Of the vitamin D analogues, calcitriol is less likely to irritate.