Mild Plaque Psoriasis — Pharmacist Checker

• Age ≥18 years — patient must be an adult.
• Prior medical diagnosis of mild plaque psoriasis of the trunk or limbs by a medical practitioner.
• History of TCS management — initial diagnosis and at least one exacerbation previously managed with TCS by a medical practitioner.
• Patient consent — informed consent obtained; patient physically present in pharmacy.

If any criterion is not met → refer to General Practitioner.

• Confirm signs & symptoms: raised red scaly patches, silvery-white scales, dry/cracked skin, itching, pain. Plaques typically symmetrical on trunk or limbs.
• Darker skin tones: plaques may be violet/darker, thicker; PASI scores may be underestimated — apply clinical judgement.
• Severity scoring: complete PASI and/or DLQI calculator. Mild = PASI ≤5 and/or DLQI ≤5.
• Patient history: medication history (prior TCS), medical history, aggravating factors, psychological impact, family history, allergies.
• Nail changes (pitting, onycholysis) — if present, refer to medical practitioner (outside pilot scope).
• GP review: refer if patient has not seen a medical practitioner for psoriasis in the previous 12 months (pharmacotherapy may still be provided if clinically appropriate).

• Patient aged under 18 years
• No prior medical diagnosis of mild plaque psoriasis
• No prior TCS management by a medical practitioner
• Patient does not consent or is not physically present
• Diagnosis is unclear
• Patient is very visibly unwell or immunocompromised
• Moderate psoriasis (PASI 6–10) — refer to GP for review and management plan
• Severe psoriasis (PASI >10) — refer to GP and Dermatology Specialist; systemic or biologic therapy may be warranted
• Face, scalp, genitals, palms or soles affected
• Body surface area >6%
• Infected or pustular lesions
• Psoriatic comorbidities: arthritis, VTE risk, depression, lymphoma, skin cancers, increased alcohol use
• Pregnant or planning pregnancy
• Nail involvement
• Taking medicines that exacerbate psoriasis: lithium, beta-blockers, NSAIDs
• Inadequate response to topical treatment
• Patient has not seen a medical practitioner for psoriasis in the last 12 months (co-referral; pharmacotherapy may still be considered)

• Supply: resupply the TCS preparation the patient has used previously (from the approved pilot medicines list — see table below).
• Check: no allergies, drug–drug interactions or contraindications. If all options contraindicated → refer to medical practitioner.
• Dispense via pharmacy dispensing software; label per Drugs, Poisons and Controlled Substances Regulation 2017.
• Non-pharmacological advice: soap-free cleanser, fragrance-free moisturiser especially after bathing; avoid scratching; flare triggers include stress, cold weather, dry skin, certain foods/drinks.
• Fingertip unit counselling for TCS application.
• Duration: trial each treatment 2–4 weeks; optimal topical response may take 3–6 months.
• Adverse effects: transient burning/stinging generally reversible on stopping. Refer if cannot be managed in pharmacy.
• Withdrawal: on good response, gradually reduce TCS frequency until stopped.
• Remind: GP review recommended at least every 12 months.

• Sufficient patient identification
• Date of treatment & pharmacist name + HPI-I number
• Patient consent (pilot participation, costs, GP communication, MHR access)
• Relevant medical/medication history, observations, assessments, allergies/ADRs
• Clinical opinion, management plan, medications supplied (form, strength, amount)
• Advice and information provided to patient
• Record in pharmacy software and approved Victorian Department of Health IT system

Share a copy of the record with the patient and (with consent) with their usual GP or medical practice.

• Moisturisers: regular use, especially after bathing/showering. Fragrance-free emollients reduce scaling, itching and water loss.
• Cleanser: soap-free cleansers only — soaps dry and irritate skin.
• Avoid scratching: keep fingernails and toenails short.
• Flare triggers: stress, cold weather, dry skin, infections, smoking, alcohol, certain medications (lithium, beta-blockers, NSAIDs), skin trauma, stopping oral steroids abruptly.
• Sun exposure: gentle sun exposure is often beneficial, but avoid sunburn.
• Patient resources: Better Health Channel 'Psoriasis'; NPS MedicineWise factsheets; Psoriasis Australia website.
• When to return: if not responding, symptoms worsen, or adverse effects develop — contact medical practitioner immediately.