General Overview

  • Red scaly (silver white) plaques with well-defined edges
  • Subtypes
    • Post-streptococcal acute guttate psoriasis
    • Small plaques psoriasis (<3cm)
    • Chronic plaque psoriasis (>3cm)
    • Unstable plaque psoriasis (stressor, rapid extension)
    • Flexural psoriasis
    • Scalp psoriasis
    • Sebopsoriasis (overlap of seborrheic dermatitis)
    • Palmoplantar psoriasis
    • Nail psoriasis (onycholysis, pitting, splinter hemorrhages, oil drop sign)
    • Erythrodermic psoriasis (rare systemic illness)
  • Associated health conditions
    • Inflammatory arthritis “psoriatic arthritis” and spondyloarthropathy - 30%
    • Inflammatory bowel disease (Crohn disease and ulcerative colitis), Coeliac disease
    • Uveitis (inflammation of the eye)
    • Metabolic syndrome


  • Mild-moderate plaque psoriasis
    • Dovobet (Calcipotriol 50 mcg/g and betamethasone 0.5 mg/g) ointment apply once daily x 4 weeks
    • High-potency topical corticosteroids (eg. Clobetasol 0.05% ointment) with ONE of the following:
      • Vitamin D analogs (Calcitriol, Calcipotriol)
      • Retinoids (Tazarotene 0.1% Gel)
      • UVB phototherapy
    • Alternatives
      • Tar / Anthralin (15% LCD solution)
  • Severe may need phototherapy, systemic therapy (methotrexate, retinoid), biologic immune modifying agents (infliximab)
    • Psoriatic arthritis: NSAID, DMARD (MTX), biologics (TNF inhibitor)


  • Scalp psoriasis
    • Consider topical treatments above in different forms, eg. Clobetasol shampoo, betamethasone valerate foam or Dovobet gel.
  • Facial/intriginous/genital psoriasis
    • Low-potency Hydrocortisone 1% cream or ointment often sufficient
    • Calcineurin inhibitors may be used (Tacrolimus 0.1% ointment, Pimecrolimus 1% cream)