GuidelinesEML (Adult Hospital STG)
Psoriasis
Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Adults 2019 Edition
L40.0-5/L40.8-9
DESCRIPTION
- This is an inflammatory condition of the skin and joints of unknown aetiology.
- Scaly red, papules and plaques over extensor surfaces and on the scalp are common.
- The nails and skin folds are often involved.
- In exceptional cases, it is localised to palms and soles and pustular skin lesions are seen, especially following rapid treatment withdrawal, e.g. steroids or systemic agents.
GENERAL MEASURES
- Counselling regarding precipitating factors and chronicity.
- Encourage sun exposure as tolerated.
MEDICINE TREATMENT
Local plaques
Maintenance therapy
- Coal tar 5%, topical, apply at night
- Avoid use on the face, flexures, and genitalia
For flares
- Potent topical corticosteroids, e.g.:
- Betamethasone 0.1%, topical, apply 12 hourly
- Decrease according to severity, reduce to hydrocortisone 1%, cream, then stop
LoE:IVbxii
Scalp psoriasis
Maintenance therapy
- Wash with coal tar containing shampoo
OR
- Coal tar 1%, topical, apply at night, under occlusion, and wash out the next morning
For flares
- Potent topical corticosteroids, e.g.:
- Betamethasone 0.1% lotion, topical, apply once daily
LoE:IVbxiii
Note
- Avoid systemic corticosteroids.
- Patient adherence is the greatest barrier to treatment success with topical therapies.
REFERRAL
- Inadequate response to topical treatment.
- Severe disease, especially if joint involvement.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Adult Hospital Level, 2020-2024_Version 1.0_07 November 2024
Chapter 4 Dermatology_4.8 Psoriasis