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Psoriasis

Useful link: http://www.pcds.org.uk/clinical-guidance/psoriasis-an-overview

Referral criteria

For people with guttate psoriasis

  • Refer urgently if lesions are widespread for consideration of phototherapy. Consider using the Advice and Guidance service.
  • The person does not respond to topical treatment e.g. dovobet, enstillar for 4 weeks (phototherapy may be an option).
  • Consider referring to an ear, nose, and throat specialist if guttate psoriasis is exacerbated by recurrent tonsillitis.

For all other types of psoriasis

Refer for same-day specialist assessment and treatment anyone with erythrodermic psoriasis and generalised pustular psoriasis. These are medical emergencies and require same-day specialist assessment and treatment.

Refer the person if:

  • Diagnostic uncertainty exists.
  • Psoriasis is extensive, for example more than 10% of the body surface area is affected.
  • Topical treatments have failed. Dovobet/Enstillar have been trialled for 4 weeks.
  • The person cannot tolerate the treatment options available in primary care.
  • There is a significant impact on physical, psychological or social well-being.
  • Refer to a rheumatologist if the person requires assessment for the management of associated arthropathy.

 

Note: Severe psoriasis is associated with an increased cardiovascular risk