Trunk and limbs
For a photo of psoriasis on limb, see here.
Reproduced with permission from the A-Z of Skin [digital]. Australasian College of Dermatologists. Sydney. https://www.dermcoll.edu.au/
A tar preparation is the preferred treatment for chronic stable psoriasis on the trunk and limbs because it is easy to apply over larger areas and can be safely used long term. Use:
LPC 4 to 8%+salicylic acid 3% cream or ointment topically, twice daily for 1 month1. coal tar + salicylic acid coal tar+salicylic acid coal tar+salicylic acid
LPC can be started at a lower concentration and increased according to response.
For an acute flare, or if a tar preparation alone is not sufficient, add a topical corticosteroid. Use:
1methylprednisolone aceponate (adult, or child 4 months or older) 0.1% cream, ointment or fatty ointment topically, once daily until skin is clear (usually 2 to 6 weeks) methylprednisolone aceponate methylprednisolone aceponate methylprednisolone aceponate
OR
1mometasone furoate 0.1% cream, hydrogel or ointment topically, once daily until skin is clear (usually 2 to 6 weeks). mometasone furoate mometasone furoate mometasone furoate
If response to treatment is inadequate after 3 weeks, use a more potent topical corticosteroid. Use:
betamethasone dipropionate 0.05% cream or ointment topically, once daily until skin is clear (usually 2 to 6 weeks). betamethasone dipropionate betamethasone dipropionate betamethasone dipropionate
Once symptoms are controlled, reduce the potency of the topical corticosteroid gradually, and withdraw if possible. Continue using the tar preparation as maintenance therapy.
For patients with only a few scattered plaques of psoriasis that do not respond to a tar preparation, or need longer-term control with a topical corticosteroid, consider a combination of calcipotriol and topical corticosteroid. Use:
calcipotriol+betamethasone dipropionate 50+500 micrograms/g ointment or foam topically, once daily until skin is clear (usually about 6 weeks). calcipotriol + betamethasone dipropionate calcipotriol+betamethasone dipropionate calcipotriol+betamethasone dipropionate
Be cautious when treating widespread psoriasis; limit use of calcipotriol ointment or foam to less than 15 g per day or 100 g per week to reduce the risk of hypercalcaemia resulting from systemic absorption. See the product information for more detail on application amounts.
If the combination of calcipotriol and topical corticosteroid is not effective, refer for dermatologist advice.
For practical information on using topical corticosteroids, tars and calcipotriol in psoriasis, see Topical drug treatment for psoriasis in primary care.