When should I consider referring a patient with nail disorders to a dermatologist?

Consider referring a patient with nail disorders to a dermatologist if:

• There is a major functional or cosmetic impact of the nail disease.
• The nail disorder is part of psoriasis and requires specialist assessment, especially if nail psoriasis severity needs to be evaluated or monitored before and after treatment.
• The diagnosis is uncertain or the nail condition is atypical or severe, suggesting the need for specialist input.
• There is suspicion of malignancy or other serious underlying conditions affecting the nails.

In particular, for patients with psoriasis involving the nails, use of the Nail Psoriasis Severity Index (NAPSI) in specialist settings is recommended to assess severity and guide treatment decisions.

Referral should also be considered when the nail disorder significantly affects the patient's quality of life or when initial management in primary care has not been effective.

These recommendations align with NICE guidance on psoriasis management and specialist referral criteria.