Prescription treatments

Although several topical treatments are available, current NICE guidance for CPP focuses on vitamin D analogues and potent topical corticosteroids. Initial treatment should include a potent topical corticosteroid, such as betamethasone, and a vitamin D analogue such as calcipotriol. These should both be applied once daily at different times (e.g. morning and evening).

Patients should be reviewed after four weeks and managed according to their response. Studies suggest that four weeks of treatment with a potent topical corticosteroid plus a vitamin D analogue produces around a 75 per cent reduction in disease severity.

Patients can stop these preparations once their skin is clear or nearly clear and has flattened. However, they should continue using emollients to help with skin hydration.

Treatment can be restarted when the disease flares. For patients who experience frequent flares, twice-weekly application on non-consecutive days of a combination product, such as Enstilar foam, can help maintain remission.

The Primary Care Dermatology Society recommends calcipotriol and betamethasone as a combination product to encourage rapid improvement and adherence in CPP. Examples include Enstilar foam for the body and scalp, Wynzora cream, and Dovobet gel and ointment.