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Psoriasis – Information for GPs

Referral criteria / commissioning position

Patients should be managed in primary care. Patients should be referred to secondary care if they have any of the following:

  • generalised pustular or erythrodermic psoriasis
  • psoriasis is acutely unstable
  • widespread symptomatic guttate psoriasis where phototherapy may be appropriate

Consider referring to secondary care in any of the following circumstances:

  • the rash fails to respond to management in general practice
  • the condition is causing severe social or psychological problems; prompts to referral should include sleeplessness, social exclusion and reduced quality of life or self-esteem
  • the rash is sufficiently extensive to make self-management impractical
  • the rash is in a sensitive area (such as face, hands, feet, genitalia) and the symptoms particular troublesome
  • the rash is leading to time off work or school sufficient to interfere with employment or education
  • they require assessment for the management of associated arthropathy (refer to rheumatology)
  • failure of previous treatment is probably best based on the subjective assessment of the patient. Sometimes failure occurs when patients are unable to apply the treatment themselves

Investigations prior to referral

Skin scrapings and nail clippings if diagnostic doubt

Information to include in referral letter

  • Extent and location of disease
  • Treatments tried already and their effects
  • Alcohol consumption
  • Effect on quality of life
  • Relevant past medical/surgical history
  • Current regular medication
  • BMI
  • Smoking status

Patient information leaflets

References

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