When should I consider referring a patient with psoriasis to a dermatologist?

Consider referring a patient with psoriasis to a dermatologist if any of the following apply:

• There is uncertainty about the diagnosis of psoriasis.
• Psoriasis is extensive, affecting more than 10% of the body surface area.
• Psoriasis is at least moderately severe, as measured by the Physician's Global Assessment.
• Psoriasis is resistant to topical drug treatments in primary care or treatments are not tolerated.
• There is a significant impact on the patient's physical, psychological, or social wellbeing.
• Additional information or education is needed, for example about the application of topical treatments such as short-contact dithranol.
• Suspected generalized pustular psoriasis or erythrodermic psoriasis, which require urgent same-day specialist dermatology assessment as a medical emergency.
• Suspected localized pustular psoriasis where specialist assessment is needed based on clinical judgement.
• When specialist treatments such as phototherapy, systemic drugs, or biologic therapy may be considered because psoriasis does not respond to topical treatments in primary care.

Additionally, arrange an urgent referral to a rheumatologist if psoriatic arthritis is suspected, but this is separate from dermatology referral.

These recommendations are based on NICE clinical guideline Psoriasis: assessment and management and supporting SIGN and expert opinion guidelines ¹.