When should I refer a patient with scalp psoriasis to a dermatologist?

Refer a patient with scalp psoriasis to a dermatologist if:

• There is no satisfactory control or clearance of scalp psoriasis after initial treatment with a potent topical corticosteroid applied once daily for up to 4 weeks.
• If after a further 4 weeks of treatment with either a different formulation of potent corticosteroid or combined topical treatments (such as calcipotriol and betamethasone dipropionate) the response remains unsatisfactory.
• If the psoriasis is severe, atypical, or involves difficult-to-treat sites, or if there is significant impact on physical, psychological, or social wellbeing.
• If there is uncertainty about diagnosis or if the disease severity and impact assessment indicate the need for specialist care.

These referral criteria ensure timely specialist input for patients not responding to standard topical treatments or with complex disease presentations.

References: NICE CG153