When to Initiate Referral
- Mild or moderate psoriasis not responding to treatment after 2 months
- Severe psoriasis with or without systemic symptoms
- Suspicion for psoriatic arthritis
- EDUCATION: Families should know that psoriasis is a chronic and relapsing disease.
- Psoriasis severity and locations determine medications used in addition to the frequency and duration of treatments.
- Topical steroids are typically used to treat a flare once to twice daily until as needed for flares, usually for 1 to 3 weeks, no longer than 15 days per month in order to minimize risk of steroid side effects (striae, telangiectasias, hypopigmentation).
- You should dispense enough medication when prescribing topicals.
- For guttate psoriasis, you should consider a throat or perianal bacterial swab culture to check for a possible strep infection that can be associated with a flare.
- You should ask about associated joint pain, redness, or swelling.
- COMPLIANCE: Make sure patients are using the medications as prescribed before switching to another regimen.
Psoriasis on the Trunk or Extremities
- Mild: Desonide 0.05% ointment or hydrocortisone 2.5% ointment to affected areas once or twice daily as needed for flares
- Moderate: Triamcinolone 1% ointment twice daily as needed for flares
Psoriasis on the Face, Ears, Eyelids, Axillae, Inguinal folds or Genitalia
- Tacrolimus 0.03% or 0.1% ointment or pimecrolimus 1% cream once or twice daily as needed for flares (medications are approved for children 2 years or older)
- Over-the-counter salicylic acid, tar-containing shampoo, or prescription ketoconazole 2% shampoo daily or at least 2 to 3 times per week
- DermaSmoothe FS Oil (fluocinolone in hypoallergenic peanut oil) or fluocinolone 01% solution once or twice daily as needed for flares in mild scalp psoriasis
- Fluocinonide 05% solution or clobetasol 0.05% solution/gel/foam once or twice daily as needed for flares in moderate to severe scalp psoriasis