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)