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