referral criteria from primary care - psoriasis

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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 (2):

  • 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 (2)

  • 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:

Last reviewed 01/2019

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