{ "schema_version": 1, "kind": "condition", "id": "psoriasis-referral", "name": "Psoriasis (Mild-to-Moderate & Referral)", "category": "chronic", "sources": "BAD Guidelines for Biological Therapies for Psoriasis 2020 · Egyptian National Drug Formulary - Endocrine System 2024 (betamethasone monograph) · Salicylic Acid Ointment BP 2% SmPC sections 4.2 and 4.4 (eMC product 4961) · Coal Tar (Exorex) Lotion SmPC sections 4.1, 4.2, 4.3 and 4.4 (eMC product 10069) · ZITHRANOL-RR (anthralin) 1.2% cream US prescribing information, Indications and Dosage and Administration (DailyMed SetID 45bad116-0351-442f-8e49-f11089a955fd) · 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) · Psoriasis - disease-level clinical article (psoriasis-referral-full.txt)", "review_status": "reviewed", "verified_against": "Egyptian National Drug Formulary - Endocrine System 2024 (betamethasone monograph) · Salicylic Acid Ointment BP 2% SmPC sections 4.2 and 4.4 (eMC product 4961) · Psoriasis - disease-level clinical article (psoriasis-referral-clinical.txt) · Psoriasis (Mild-to-Moderate & Referral) - disease-level clinical article (psoriasis-referral-full.txt) · Coal Tar (Exorex) Lotion SmPC sections 4.1, 4.2, 4.3 and 4.4 (eMC product 10069) · ZITHRANOL-RR (anthralin) 1.2% cream US prescribing information, Indications and Dosage and Administration (DailyMed SetID 45bad116-0351-442f-8e49-f11089a955fd) · 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) · Psoriasis - disease-level clinical article (psoriasis-referral-full.txt)", "verified_date": "2026-08", "treatments": [ { "id": 1553, "generic": "Betamethasone", "line": 1, "is_adjunct": false, "form": "topical", "strength_mg": null, "adult_dose": "Once to twice daily. (for adults and children).", "adult_duration": null, "dose_source": "Egyptian National Drug Formulary - Endocrine System 2024 (betamethasone monograph)", "rationale": "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.", "cautions": [ "Avoid prolonged continuous use to prevent skin atrophy and striae.", "Do not use on face or flexures without specialist advice.", "Refer severe (>10% body surface area) or erythrodermic psoriasis urgently.", "The Egyptian formulary limits a course to 5 days when this is used on the face or in a child - 0.1% betamethasone is potent and the face thins fastest." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "For adults and children over 1 year:", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "CRONOMESONE 0.1% CREAM 15 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHAROPHARMA", "price_egp": 4.0, "pack_count": null, "unit_price": null, "strength_mg": 15000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CRONOMESONE 0.1% OINT. 15 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHAROPHARMA", "price_egp": 4.0, "pack_count": null, "unit_price": null, "strength_mg": 15000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "BETNOVATE 0.1% TOP. OINT. 15 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SMITHKLINE BEECHAM > GLAXO SMITHKLINE", "price_egp": 6.9, "pack_count": null, "unit_price": null, "strength_mg": 15000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "BETAMETHASONE DIPROPIONATE 0.05% CREAM 20 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AMRIYA", "price_egp": 11.5, "pack_count": null, "unit_price": null, "strength_mg": 20000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "BETAVAL 0.1% OINT. 15 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ARAB DRUG COMPANY (ADCO)", "price_egp": 15.0, "pack_count": null, "unit_price": null, "strength_mg": 15000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "BETADERM 0.1% TOPICAL OINT. 15 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EIPICO", "price_egp": 18.0, "pack_count": null, "unit_price": null, "strength_mg": 15000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "BETNOVATE 0.1% TOPICAL CREAM 15 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SMITHKLINE BEECHAM > GLAXO SMITHKLINE", "price_egp": 21.0, "pack_count": null, "unit_price": null, "strength_mg": 15000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "BETADERM 0.1% CREAM 30 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EIPICO", "price_egp": 23.0, "pack_count": null, "unit_price": null, "strength_mg": 30000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "psoriasis-referral" }, { "id": 1555, "generic": "Referral & safety-netting (no drug therapy)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": null, "adult_duration": null, "dose_source": "Psoriasis - disease-level clinical article (psoriasis-referral-clinical.txt)", "rationale": "Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.", "cautions": [ "RED FLAG - Pustular and erythrodermic psoriasis can be life-threatening.", "RED FLAG - Extensive disease, or involvement of nails and psoriatic arthritis, is a threshold for systemic (specialist) therapy.", "RED FLAG - The explicit severity thresholds for referral are >10% BSA, or involvement of face, nails, scalp, genitals, flexures, or soles." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": null, "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "psoriasis-referral" }, { "id": 1556, "generic": "Coal tar", "line": 1, "is_adjunct": false, "form": "topical", "strength_mg": null, "adult_dose": "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.\"", "adult_duration": "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.\"", "dose_source": "Coal Tar (Exorex) Lotion SmPC sections 4.1, 4.2, 4.3 and 4.4 (eMC product 10069)", "rationale": "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.", "cautions": [ "Not on broken or inflamed skin. SmPC verbatim: \"Exorex should not be applied to inflamed or broken skin (open exuding wounds or infection of the skin).\"", "Contraindicated with folliculitis or acne. SmPC verbatim: \"Presence of folliculitis and acne vulgaris.\"", "It makes the skin burn more easily in sun. SmPC verbatim: \"Coal tar enhances photosensitivity of the skin, and exposure to direct sunlight after application of Exorex should be avoided.\" That is a daily consideration in Cairo.", "Avoid in photosensitive disease. SmPC verbatim: \"Exorex should not be used on patients who have disease characterised by photosensitivity such as lupus erythematosus or allergy to sunlight.\"", "It stains skin, clothing and bedding, and it smells - warn the patient before the first tube rather than after." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "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.\"", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "psoriasis-referral" }, { "id": 1557, "generic": "Dithranol", "line": 1, "is_adjunct": false, "form": "topical", "strength_mg": null, "adult_dose": "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.\"", "adult_duration": "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.\"", "dose_source": "ZITHRANOL-RR (anthralin) 1.2% cream US prescribing information, Indications and Dosage and Administration (DailyMed SetID 45bad116-0351-442f-8e49-f11089a955fd)", "rationale": "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.", "cautions": [ "Not on acute or inflamed psoriasis. US label verbatim: \"Zithranol-RR is contraindicated for patients with acute or actively inflamed psoriatic eruptions or a history of hypersensitivity to any of the ingredients.\"", "Keep it off normal skin, the face and the flexures. US label verbatim: \"Avoid contact with the eyes or mucous membranes. Exercise care when applying Zithranol-RR cream to the face or intertriginous skin areas.\"", "Stop it if the skin reacts. US label verbatim: \"Discontinue use if a sensitivity reaction occurs or if excessive irritation develops.\"", "It stains. US label verbatim: \"To prevent the possibility of staining clothing or bed linen, it may be advisable to use protective dressings.\" and \"Contact with fabrics, plastics and other materials may cause staining and should be avoided. Always wash hands thoroughly after use.\" Rinse the bath immediately - \"always rinse the tub/shower with lukewarm water immediately after washing/showering\". Purple-brown staining of treated skin is expected and fades." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "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.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "PSORANOL 100MG/100GM CREAM 20 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ALFACURE PHARMACEUTICALS", "price_egp": 4.0, "pack_count": null, "unit_price": null, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ANTHRAMASH 1% CREAM 20 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "DEBEIKY > MASH PREMIERE", "price_egp": 18.0, "pack_count": null, "unit_price": null, "strength_mg": 20000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ANTHRAWEST 1% CREAM 20 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "WESTERN PHARMACEUTICALS INDUSTRIES > WESTERN PHARMA", "price_egp": 18.0, "pack_count": null, "unit_price": null, "strength_mg": 20000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "psoriasis-referral" }, { "id": 1558, "generic": "Infliximab", "line": 3, "is_adjunct": false, "form": "injection", "strength_mg": null, "adult_dose": "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.\"", "adult_duration": "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.\"", "dose_source": "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)", "rationale": "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.", "cautions": [ "RED FLAG - tuberculosis is excluded before the first infusion, not after it. SmPC verbatim: \"Before starting treatment with infliximab, all patients must be evaluated for both active and inactive ('latent') tuberculosis.\" and \"Appropriate screening tests, (e.g. tuberculin skin test, chest X-ray, and/or Interferon Gamma Release Assay), should be performed in all patients\". The SmPC also warns that \"in the majority of these reports tuberculosis was extrapulmonary\". Latent tuberculosis is common in Egypt, so this is a real gate rather than a formality.", "Hepatitis is screened for alongside tuberculosis - the disease article asks for both to be worked up before any biological agent is started.", "Infection risk runs for months after the last infusion. SmPC verbatim: \"Patients must be monitored closely for infections including tuberculosis before, during and after treatment with infliximab. Because the elimination of infliximab may take up to six months, monitoring should be continued throughout this period. Further treatment with infliximab must not be given if a patient develops a serious infection or sepsis.\" A blunted fever is part of the hazard - \"suppression of TNF may mask symptoms of infection such as fever\".", "Contraindicated outright in some patients. SmPC verbatim: \"Patients with tuberculosis or other severe infections such as sepsis, abscesses, and opportunistic infections\" and \"Patients with moderate or severe heart failure (NYHA class III/IV)\".", "An intravenous hospital drug, not a prescription pad drug. SmPC verbatim: \"Remsima infusions should be administered by qualified healthcare professionals trained to detect any infusion-related issues.\" and \"Infliximab has been associated with acute infusion-related reactions, including anaphylactic shock, and delayed hypersensitivity reactions\"." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "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.\"", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "REMICADE 100 MG PD. VIAL FOR I.V. INF. 10 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "JANSSEN CILAG > SOFICOPHARM", "price_egp": 5936.0, "pack_count": null, "unit_price": null, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "psoriasis-referral" }, { "id": 1554, "generic": "Salicylic acid", "line": 2, "is_adjunct": true, "form": "topical", "strength_mg": null, "adult_dose": "Adults, children and the elderly: apply twice daily to the affected area.", "adult_duration": null, "dose_source": "Salicylic Acid Ointment BP 2% SmPC sections 4.2 and 4.4 (eMC product 4961)", "rationale": "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.", "cautions": [ "Salicylic acid is a keratolytic agent used to remove scale prior to topical steroid application.", "Avoid contact with eyes, mucous membranes, or inflamed skin.", "Salicylate can be absorbed through skin: over large areas, for long stretches, or on a neonate it causes real poisoning. Tinnitus, dizziness or deafness means stop.", "Fabric (clothing, bedding, dressings etc.) that has been in contact with this product burns more easily and is a serious fire hazard." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Avoid application over large surface areas in young children", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "SALICYLIC ACID COLLODION 12% PAINT B.P.2001", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "UNIPHARMA CO. > UNIPHARMA", "price_egp": 3.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "SALICYLIC ACID SOAP (WEISER) 45 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "WEISER", "price_egp": 15.0, "pack_count": null, "unit_price": null, "strength_mg": 45000.0, "exact_strength": true, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "psoriasis-referral" } ] }