Psoriasis (Mild-to-Moderate & Referral)

Once to twice daily. (for adults and children).

For adults and children over 1 year:

Egyptian National Drug Formulary - Endocrine System 2024 (betamethasone monograph)

Betamethasone is a potent topical corticosteroid that reduces the inflammation and scaling of psoriatic plaques; it is first-line topical therapy for mild-to-moderate psoriasis, used in short courses to limit skin atrophy.

Psoriasis - disease-level clinical article (psoriasis-referral-clinical.txt)

Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.

Adults, children and the elderly: apply twice daily to the affected area.

Avoid application over large surface areas in young children

Salicylic Acid Ointment BP 2% SmPC sections 4.2 and 4.4 (eMC product 4961)

Salicylic acid is a keratolytic that breaks down the intercellular matrix holding thick psoriatic scale together; it is used as an adjunct to strip scale from hyperkeratotic plaques so topical corticosteroids can penetrate more effectively, not as treatment on its own.

Applied to clean skin. SmPC verbatim: "Ensure that the lesions are clean. Apply a thin layer of Exorex two to three times per day to the affected areas. Massage gently and leave to dry." - Continued while it helps and stopped if the skin becomes irritated. SmPC verbatim: "Coal tar may cause skin irritation. If irritation occurs, the treatment should be reviewed and discontinued if necessary."

Licensed from 12 years at full strength, diluted below that. SmPC verbatim: "Adults and children over 12 years of age" apply it at full strength; "For young children under 12 years of age and the elderly" - "The emulsion may be diluted by mixing with a few drops of freshly boiled and cooled water in the palm of the hand."

Coal Tar (Exorex) Lotion SmPC sections 4.1, 4.2, 4.3 and 4.4 (eMC product 10069)

The disease article names it among the topicals used first, verbatim: "Topical agents used are coal tar, dithranol, corticosteroids, vitamin D analog, and retinoids are used initially." The SmPC's indication line names the disease and nothing else, verbatim: "Exorex is for the treatment of psoriasis of the skin and scalp." Egypt registers no plain coal tar preparation licensed for psoriasis - the six coal-tar products on the register are combination hair-care shampoos and lotions - so the row may show no therapeutic brand, which is the truth about what is on the shelf rather than a gap in the source.

No Egyptian brand matched — prescribe by generic name.

Once daily, contact time built up rather than started long. US label verbatim: "Generally, it is recommended that Zithranol-RR cream be applied once a day." Where the patient's response to it is not yet known, the label directs a short contact time of 5 to 15 minutes for at least one week, then verbatim: "When a short contact time is used initially, it can be increased stepwise to thirty minutes before removing the cream by washing or showering." Application verbatim: "Apply sparingly to the psoriatic lesions avoiding normal skin and rub gently and carefully into the skin." Wash it off with cool water - "At the end of each period of treatment, rinse the skin thoroughly with cool to lukewarm water before washing with soap." - Contact time is titrated to the individual. US label verbatim: "The optimal period of contact will vary according to the patient's response to treatment."

No separate paediatric dose is stated in the label used here. The short-contact method, staining and irritation make it a poor fit for a small child; a corticosteroid or tar preparation is the usual first move, and refractory childhood psoriasis belongs with dermatology.

ZITHRANOL-RR (anthralin) 1.2% cream US prescribing information, Indications and Dosage and Administration (DailyMed SetID 45bad116-0351-442f-8e49-f11089a955fd)

The disease article lists it among the topicals used first-line, alongside coal tar, corticosteroids, a vitamin D analogue and the retinoids. The US label's indication covers topical treatment of stable plaque psoriasis. The label calls the molecule anthralin, the article calls it dithranol - they are the same drug, and Egypt registers it under both names: ANTHRAMASH and ANTHRAWEST 1% cream at 18 EGP as anthralin, PSORANOL 1% cream at 4 EGP as dithranol. Either name finds the same drug.

Intravenous infusion, dosed by body weight. SmPC verbatim: "5 mg/kg given as an intravenous infusion followed by additional 5 mg/kg infusion doses at 2 and 6 weeks after the first infusion, then every 8 weeks thereafter." - Stopped at 14 weeks if four doses have not worked. SmPC verbatim: "If a patient shows no response after 14 weeks (i.e. after 4 doses), no additional treatment with infliximab should be given."

Not a paediatric prescription in this disease. SmPC verbatim: "The safety and efficacy of infliximab in children and adolescents younger than 18 years for the indication of psoriasis have not been established."

Remsima 100 mg powder for concentrate for solution for infusion (infliximab) SmPC sections 4.1, 4.2, 4.3 and 4.4 (eMC product 3709)

The disease article names it first among the biologics, verbatim: "Biologicals are manufactured proteins that interrupt the immune process in psoriasis which are infliximab, adalimumab, etanercept, and interleukin antagonists." and places it precisely, verbatim: "Infliximab is reserved for patients with severe disease in whom other biological agents cannot be used". The SmPC's indication section names the disease, verbatim: "Remsima is indicated for treatment of moderate to severe plaque psoriasis in adult patients who failed to respond to, or who have a contraindication to, or are intolerant to other systemic therapy including ciclosporin, methotrexate or psoralen ultra-violet A (PUVA)." Egypt registers one infliximab product, REMICADE 100 mg powder for intravenous infusion at roughly 5,900 EGP a vial, and a course is several vials per infusion at adult body weights.