Reviewed on : 2 Aug 2021

Reviewed by : Gateway Editor

Expires : 2 Aug 2023

Psoriasis is a common disorder with a strong genetic disposition.

It is frequently encountered as plaques which the size of and involvement of vary widely.

Classical sites are the scalp, knees, elbows and base of spine, however, lesions of psoriasis can appear anywhere on the body surface

Record patient history

1. Duration of psoriasis
2. Possible triggers – infection, stress, alcohol, drugs
3. Family history of psoriasis
4. Occupation (including effect of disease)
5. Medical history
6. Drug history
7. Patient expectations and ability to comply with treatment
8. Quality of Life

Physical examination

1. Check sites (elbows, knees, trunk, scalp, flexures, nails)
2. Note character of lesions (demarcation, scales, thickness, erythema, pustulation)
3. Note extent of cover
4. Assess degree of itching and pain
5. Assess associations, eg. arthropathy

Types of psoriasis and recommended treatments

Pre referral investigations

FBC, LFTs, fasting lipids, three sets of U&Es (within last 4 months) if patient is likely to start systemic therapy

Referral criteria

• The rash fails to respond to management in primary care.
• The rash is in a sensitive area (face, hands, feet, genitalia) and the symptoms are particularly troublesome.
• The rash is sufficiently extensive to make self-management impractical.
• The condition is causing severe social and psychological problems.
• The patient has widespread guttate psoriasis (so that he /she can benefit from early phototherapy)
• The patient’s psoriasis is acutely unstable.
• The patient has generalised pustular or erythrodermic psoriasis.
• Possible use and consideration of systemic therapy for management of widespread or unstable psoriasis.
• The rash is leading to time off work or school.
• The patient requires assessment for the management of associated arthropathy.