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Table 3-1

Type of psoriasisFirst lineSecond lineReview patient
Localised stable plaques

Tar preparations

Vitamin D analogues

Salicylic acid preparations

Topical steroids

Dithranol/ichthammol

TL01 (UVB)

Initial review after 4-6 wk, once established 3-4 mo
Extensive stable plaques (usually more than 10% body surface area affected)

TL01 (UVB)

PUVA

Acitretin

PUVA + Acitretin

Methotrexate

Ciclosporin A

Hydroxyurea

Biological agents

Initially review after 2-4 wk, once established 3-4 mo
Widespread small plaqueTL01 (UVB)Steroid with LPC4-6 wk
Guttate psoriasis

Moderate-potency topical steroids

TL01 (UVB)

Steroid with LPC4-6 wk
Facial psoriasisMild-moderate potency topical steroidSteroid with LPC4-6 wk
Flexural psoriasisMild-moderate potency topical steroid + antifungalMethotrexate4-6 wk then 3-4 mo
Pustular psoriasis of hands and feet

Moderate-potency topical steroids

Potent topical steroid + propylene glycol ± occlusion

Acitretin

Methotrexate

Hand and foot PUVA

4-6 wk initial review and then 3-4 mo into phototherapy or systemic therapy
Acute erythrodermic, unstable/generalised pustular psoriasis

In-patient management

Short-term mild topical steroids

Methotrexate

Ciclosporin

Biological therapy

Daily review initially then weekly

Key: PUVA, psoralen with ultraviolet A; TL01, narrow-band ultraviolet B; UVB broad band ultraviolet B; LPC, Liquor Picis Carbonis.