Psoriasis affects around 1.8 million people in the UK, according to the Psoriasis Association — roughly 2-3% of the population. It is a chronic, immune-mediated skin condition that community pharmacists encounter frequently, both in dispensing prescriptions and in managing OTC requests. Mild psoriasis can often be managed entirely in the pharmacy, but recognising when to escalate is critical.

Understanding the condition

Psoriasis is characterised by well-demarcated, erythematous plaques with silvery-white scale, most commonly on the elbows, knees, scalp, and lower back. It is not contagious — a point pharmacists may need to reinforce to patients who face stigma.

The most common form is chronic plaque psoriasis (affecting about 80% of patients). Other variants include guttate psoriasis (small droplet-shaped lesions, often post-streptococcal), scalp psoriasis, nail psoriasis, and flexural (inverse) psoriasis.

Around 30% of people with psoriasis develop psoriatic arthritis, according to the National Psoriasis Foundation. Pharmacists should ask about joint pain and stiffness in psoriasis patients, as early rheumatology referral improves outcomes.

OTC pharmacy treatment

Emollients — the foundation

Emollients are the cornerstone of psoriasis management at every severity level. They reduce scaling, soothe itching, and improve the effectiveness of active topical treatments. NICE guideline CG153 recommends emollient use for all people with psoriasis.

Key counselling points:

• Apply liberally and frequently — at least twice daily and after bathing
• Apply in the direction of hair growth to reduce folliculitis risk
• Use as soap substitutes — conventional soaps strip natural oils and worsen psoriasis. Emollient wash products (e.g. Dermol, Cetraben, Epaderm) should replace all soap and shower gel.
• Fire risk with paraffin-based emollients — bandages, clothing, and bedding contaminated with paraffin-based emollients can ignite easily. The MHRA issued a safety alert. Patients should be warned, particularly those who smoke or use electric heaters.
• Pump dispensers are more hygienic than tubs (which can harbour bacteria if fingers are dipped repeatedly)

Coal tar preparations

Coal tar has been used for psoriasis for over a century and remains available OTC. It has anti-inflammatory, anti-scaling, and anti-pruritic properties.

• Shampoos: Polytar, Alphosyl, T/Gel — useful for scalp psoriasis. Apply, leave on for 5-10 minutes, then rinse. Can be used two to three times weekly.
• Creams and ointments: Exorex (coal tar 1%), Psoriderm — for body plaques. Cosmetically less elegant than modern treatments but effective.
• Bath additives: Polytar Emollient, Psoriderm — added to bath water.

Counselling: coal tar stains clothing and bedding (use old sheets). It has a distinctive smell that some patients find unacceptable. It can cause photosensitivity — advise sun protection on treated areas. Despite concerns, there is no convincing evidence that therapeutic coal tar preparations increase cancer risk at the concentrations used.

Salicylic acid

Salicylic acid (2-6%) is a keratolytic that helps remove thick scale before applying active treatments. Available in combination with coal tar in some products. Useful for thick plaques on elbows and knees, and for scalp psoriasis (Cocois ointment — coconut oil, coal tar, and salicylic acid).

Prescription treatments pharmacists should know

While pharmacists cannot supply these OTC, understanding them improves counselling:

Vitamin D analogues (calcipotriol, tacalcitol, calcitriol): first-line topical prescription treatment per NICE. Apply to plaques, not normal skin. Maximum 100g per week for calcipotriol to avoid hypercalcaemia. Skin irritation is common initially.

Topical corticosteroids: used for flares. Potency should match the body site — mild (hydrocortisone 1%) for face and flexures; potent (betamethasone) for body plaques. Not for continuous long-term use due to skin thinning.

Calcipotriol/betamethasone combination (Enstilar, Dovobet): popular first-line combination. Enstilar foam is well-accepted by patients. Usually used for four weeks, then calcipotriol alone for maintenance.

Dithranol (Dithrocream): effective but stains skin and clothing purple-brown. Requires careful application to plaques only (petroleum jelly on surrounding skin to protect). Short-contact therapy (30 minutes then wash off) is most practical.

Scalp psoriasis: a special challenge

Scalp psoriasis is common, visible, and distressing. The pharmacy approach:

1. Descale first — coconut oil or olive oil applied overnight under a shower cap, then combed out
2. Medicated shampoo — coal tar (Polytar, T/Gel) or ketoconazole (if fungal co-infection suspected)
3. If inadequate — refer for topical corticosteroid scalp applications (Betnovate scalp application, Elocon)

Pharmacists should ask about scalp involvement in any psoriasis consultation — patients often focus on body plaques and forget to mention the scalp.

Triggers to discuss

Pharmacists can help patients identify and manage triggers:

• Stress — the most commonly reported trigger; pharmacists can signpost to stress management resources
• Infections — streptococcal throat infections can trigger guttate psoriasis flares
• Medications — lithium, beta-blockers, antimalarials, and NSAIDs can worsen psoriasis. Check the patient's medication list.
• Alcohol — excessive alcohol worsens psoriasis and reduces treatment adherence
• Smoking — associated with increased psoriasis severity
• Skin trauma — the Koebner phenomenon (new psoriasis at sites of injury) means patients should avoid scratching or picking plaques

When to refer

• More than 10% body surface area affected — specialist assessment needed; likely requires phototherapy or systemic treatment
• Facial or genital involvement — requires careful treatment selection
• Suspected psoriatic arthritis — joint pain, stiffness, or swelling in a psoriasis patient
• Guttate psoriasis — sudden onset of multiple small plaques, often following sore throat
• Pustular or erythrodermic psoriasis — medical emergency; widespread pustules or erythema
• Significant psychological impact — psoriasis substantially affects quality of life; mental health support may be needed
• Failure of OTC treatment after four to eight weeks

The pharmacy role

Community pharmacists are central to psoriasis management. Emollient consultations, scalp treatment advice, and trigger identification are core pharmacy activities. The New Medicine Service supports patients starting vitamin D analogues or topical corticosteroids. For patients wanting to find pharmacies with extended consultation services, PharmSee's pharmacy finder is a useful starting point.

PharmSee tracks 1,715 active pharmacy vacancies across England. Community and hospital roles with dermatology components are available, and the salary guide provides benchmarking for specialist-adjacent roles.

Sources

• NICE guideline CG153: Psoriasis — assessment and management (2012, updated 2017)
• Psoriasis Association: prevalence data and patient resources
• BNF: coal tar, emollient, vitamin D analogue, corticosteroid monographs
• MHRA: paraffin-based emollient fire risk safety alert
• PharmSee vacancy tracker: 1,715 active roles as of 15 April 2026