Scalp Psoriasis — SCE Dermatology MCQ
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Correct answer: A — Calcipotriol/Betamethasone cutaneous foam (Enstilar) — designed for improved scalp and body application
The correct answer is A, Calcipotriol/Betamethasone cutaneous foam (Enstilar), designed for improved scalp and body application. Scalp psoriasis is notoriously difficult to treat because hair impedes even distribution of creams, ointments and gels, reducing contact time and adherence. The fixed combination aerosol foam contains calcipotriol (vitamin D analogue) and betamethasone dipropionate (potent corticosteroid), and its formulation allows it to spread easily through hair, dry quickly without residue, and deposit effectively on affected skin, making it a practical once-daily alternative when standard topical vehicles are unacceptable to the patient. UK guidance recognises formulation choice as central to improving concordance in scalp disease, since poor cosmetic acceptability is a major driver of non-adherence. Why the other options are wrong: E. Intramuscular injection: there is no licensed intramuscular preparation for localised scalp psoriasis; systemic injectable therapies (biologics) are reserved for moderate to severe disease unresponsive to topical and phototherapy, not simply for application difficulty. B. Rectal administration: no psoriasis treatment is delivered rectally; this route has no plausible pharmacological or practical basis for a cutaneous scalp condition. C. Intravenous infusion of topical preparation: topical preparations are formulated for cutaneous use only; administering them intravenously would be unsafe, unlicensed and pharmacologically inappropriate. D. Oral tablets only: oral systemic agents (e.g. methotrexate, acitretin) are stepped-up treatments for extensive or resistant psoriasis, not first-line solutions for a hair-related application problem, and carry systemic toxicity risks disproportionate to isolated scalp involvement. Key point: when hair impairs application of conventional scalp topicals, switching vehicle (e.g. to an aerosol foam like Enstilar) rather than escalating to a systemic route is the appropriate next step.
Reference: NICE CKS, Psoriasis: Scenario - Scalp psoriasis and Prescribing information, cks.nice.org.uk/topics/psoriasis/ (accessed 2024); Enstilar SmPC, medicines.org.uk