Referral criteria from primary care - psoriasis

Referral criteria from primary care - psoriasis

Supervision of a consultant dermatologist is needed in the cases of:

• patients with extensive disease who require secondary care treatment with systemic agents and phototherapy (due to the side effects of therapy)
• patients with unresponsive rashes (1)

Referral criteria (1):

• following assessment in a non-specialist setting, refer people for dermatology specialist advice if:
  • there is diagnostic uncertainty or
  • any type of psoriasis is severe or extensive, for example more than 10% of the body surface area is affected or
  • any type of psoriasis cannot be controlled with topical therapy or
  • acute guttate psoriasis requires phototherapy or
  • nail disease has a major functional or cosmetic impact or
  • any type of psoriasis is having a major impact on a person's physical, psychological or social wellbeing
    
    
• people with generalised pustular psoriasis or erythroderma should be referred immediately for same-day specialist assessment and treatment
  
  
• refer children and young people with any type of psoriasis to a specialist at presentation.

Also specialist referral is required if a patient needs assessment for the management of associated arthropathy (1)

• assessment and referral for psoriatic arthritis
  • as soon as psoriatic arthritis is suspected, refer the person to a rheumatologist for assessment and advice about planning their care.

A PASI score is a tool used to measure the severity and extent of psoriasis (Psoriasis Area and Severity Index)

• be aware that topical treatment alone may not provide satisfactory disease control, especially in people with psoriasis that is extensive (for example more than 10% of body surface area affected) or at least 'moderate' on the static Physician's Global Assessment
  
  

Reference:

1. Psoriasis: The assessment and management of psoriasis. NICE Clinical Guideline (October 2012 - last updated September 2017)