Management of Psoriasis

Assessment

Usually, symmetrical erythematous plaques with a silvery surface scale.
Typically occurs on extensor surfaces, or affects a larger body surface area (generalised) and can present with an erythrodermic flare (erythroderma means around 90% of the body surface area is bright red and patient is generally unwell).
Flexural psoriasis occurs at skin fold sites and usually lacks scale.
Psoriatic nail changes may be present (pitting, onycholysis, hyperkeratosis).

See Figure 1 for image of psoriasis.

Treatment options

Below is a stepped approach for newly diagnosed psoriasis. Patients with pre-existing psoriasis should be treated according to their symptoms and usual regular topical regime.

Prescribe regular emollients four times a day. Examples include: Zerobase^® cream, Cetraben^® cream or liquid and white soft paraffin ointment. See West of Scotland Formulary for preferred choice. Important prescribing points:

In general, ointments are preferred for dry skin but are poorly tolerated.
Creams and lotions are better tolerated but may sting inflamed skin.
Epimax products should not be used on the face nor near the eyes.

Topical treatments

Trunk & limbs: Calcipotriol 50 microgram per 1 gram ointment (in combination with betamethasone 0.05% ointment) once a day for 7 days (acute flare).
Can continue above twice weekly as a regular maintenance regime.
Prescribe appropriate quantities, dependent on total body surface area involved e.g. 2 x 120 gram tubes or cans.
Face: Clobetasone butyrate 0.05% (Eumovate^®) once a day for 7 days (acute flare).

Descaling treatments

For lesions with thick scale, it may be necessary to use descaling agents e.g. salicylic acid 5% in yellow soft paraffin. See West of Scotland Formulary.
Consider tubular bandages for limbs.

Consider referral to local dermatology team

Severe psoriasis not responding to regular topical treatment.
Suspected erythrodermic or pustular psoriasis (yellow / white pustules within psoriasis plaques).
Where there is diagnostic uncertainty.

General measures

Referral to GP surgery for skin monitoring post-discharge.
Provide patient information leaflet from the British Association of Dermatologists website.
Raise awareness of patient support groups.
Assess patients for related comorbidities e.g. obesity, dyslipidaemia, metabolic dysfunction-associated steatotic liver disease (MASLD), cardiovascular disease, psoriatic arthritis, inflammatory bowel disease, anxiety / depression.
Consider referral to Dermatology Specialist Nurse.

Guideline reviewed: February 2026

Page last updated: August 2026