ALARM SYMPTOMS

- Ketidak pastian diagnostik

- Semua psoriasis parah, misalnya lebih dari 10% permukaan tubuh terkena
psoriasis
- Semua tipe psoriasis yang tidak bisa dikontrol dengan penggunaan obat topikal
- Psoriasis guttate akut membutuhkan fototerapi
- Semua tipe psoriasis yang memiliki dampak besar pada fisik, psikologi, maupun
sosial seseorang.
- Seseorang dengan psoriasis pustular atau ererythroderma.

https://pathways.nice.org.uk/pathways/psoriasis/psoriasis-overview#content=view-node:nodes-specialist-referral
NICE Guidelines for psoriasis
Terapi pengobatan bersifat hirarkis dan tergantung pada tingkat keparahan, situs,
usia, jenis kelamin dan pekerjaan. Obat sistemik memiliki lebih banyak risiko;
Methotreaxte bersifat hepatotoksik dan ciclosporin bersifat nephrotoxic. Namun
dapat diberikan terapi berupa:

Terapi topikal
1. Calcipotriol or tacalcitol
2. Topical steroids
3. Dithranol

Second-line
Second-line treatment may include phototherapy (PUVA) or systemic therapy with
methotrexate, etretinate or ciclosporin (cyclosporin). Unfortunately, all of these
have potentially serious side effects. Methotrexate has been shown to be effective
in nonrandomised trials but relapse usually occurs within 6 months of
discontinuation. Long term methotrexate treatment carries the risk of liver
damage. Those not responding to PUVA or systemic therapy may be prescribed
biologics (etanercept, adalimumab or ustekinumab), which block part of the
immune system involved in causing inflammation.
 Calcipotriol
Plaque psoriasis, Scalp psoriasis
KONTRA- Calcium metabolism disorders
INDIKASI
PERHATIAN Avoid excessive exposure to sunlight and sunlamps, avoid use on face,
KHUSUS erythrodermic exfoliative psoriasis (enhanced risk of hypercalcaemia),
generalised pustular psoriasis (enhanced risk of hypercalcaemia)
PREGNANCY Manufacturers advise avoid unless essential.
EFEK Common or very common Burning, dermatitis, erythema, itching, local
SAMPING skin reactions. paraesthesia
Rare Facial dermatitis, perioral dermatitis
Frequency not known Aggravation of psoriasis, dry skin,
photosensitivity
DOSIS Plaque psoriasis
TO THE SKIN USING OINTMENT
Adult: Apply 12 times a day, when preparations are used together
maximum total calcipotriol 5 mg in any one week (e.g. scalp solution 60
mL with ointment 30 g or scalp solution 30 mL with ointment 60 g);
maximum 100 g per week
DOSIS Scalp psoriasis
TO THE SKIN USING SCALP LOTION
Adult: Apply twice daily, when preparations are used together maximum
total calcipotriol 5 mg in any one week (e.g. scalp solution 60 mL with
ointment 30 g or scalp solution 30 mL with ointment 60 g); maximum
60 mL per week

Tacalcitol
Plaque psoriasis
KONTRA- Calcium metabolism disorders
INDIKASI
PERHATIAN Avoid eyes, erythrodermic exfoliative psoriasis (enhanced risk of
KHUSUS hypercalcaemia), generalised pustular psoriasis (enhanced risk of
hypercalcaemia), if used in conjunction with UV treatment
If tacalcitol is used in conjunction with UV treatment, UV radiation
should be given in the morning and tacalcitol applied at bedtime.
PREGNANCY Manufacturer advises avoid unless no safer
alternativeno information available.
BREAST FEEDING Manufacturer advises avoid application to breast
area; no information available on presence in milk.
MONITORING REQUIREMENTS Monitor serum calcium if risk of
hypercalcaemia
EFEK Common or very common Burning, dermatitis, erythema, itching, local
SAMPING skin reactions, paraesthesia
Frequency not known Aggravation of psoriasis
DOSIS TO THE SKIN
Adult: Apply once daily, preferably at bedtime, maximum 10 g ointment
or 10 mL lotion daily, when lotion and ointment used together,
maximum total tacalcitol 280 micrograms in any one week (e.g. lotion
30 mL with ointment 40 g)

Dithranol (Anthralin)
Subacute and chronic psoriasis
KONTRA- Acute and pustular psoriasis, hypersensitivity
INDIKASI
PERHATIAN Avoid sensitive areas of skin. avoid use near eyes
KHUSUS PREGNANCY No adverse effects reported.
BREAST FEEDING No adverse effects reported.
EFEK Local burning sensation, local irritation, stains hair, stains skin
SAMPING