Psoriasis: Special situations treatments

Special situations

Scalp psoriasis

This is often recalcitrant. Oily preparations contain-ing 3% salicylic acid are useful (Formulary 1). They should be rubbed into the scalp three times a week and washed out with a tar shampoo 4 – 6 h later. If progress is slow, they can be left on for one or two nights before shampooing. Salicylic acid and tar com-binations are also effective.

Guttate psoriasis

A course of penicillin V or erythromycin is indicated for any associated streptococcal throat infection. Bland local treatment is often enough as the natural trend is towards remission. Suitable preparations include emulsifying ointment and zinc and ichthammol cream. Tar–steroid preparations are reasonable alternatives. A course of ultraviolet therapy (UVB) may be helpful after the eruptive phase is over.

Eruptive/unstable psoriasis

Bland treatment is needed and rest is important. Tar, dithranol and ultraviolet therapy are best avoided. Suitable preparations include emulsifying ointment and zinc and ichthammol cream.