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Psoriasis

Checked: 23-08-2020 by Vicky Ryan Next Review: 23-08-2021

Principles of Management

Local clinicians recommend:

Primary Care Dermatology Society: Psoriasis clinical guidance

Principles of management - Focus on step one to four of Primary Care Dermatology Society management guideline, prior to referral.

National Institute of Health and care Excellence (NICE): CKS: https://cks.nice.org.uk/psoriasis

Please always refer to the BNSSG Formulary for the latest prescribing guidance.

Red Flags

Acute generalised pustular psoriasis is a rare form of psoriasis. It presents as widespread pustules on background of red and tender skin.

For more information- http://www.pcds.org.uk/clinical-guidance/psoriasis-generalised-pustular-psoriasis

Erythrodermic psoriasis: A potentially life threatening condition that should be managed as a medical emergency if suspected: https://cks.nice.org.uk/psoriasis

PATIENTS ARE OFTEN UNWELL WITH BOTH ACUTE GENERALISED PUSTULAR AND ERYTHRODERMIC PSORIASIS AND NEED ADMISSION- CONTACT ON CALL DERMATOLOGIST

Referral

Uncomplicated psoriasis can often be diagnosed and managed in primary care.

If advice or confirmation of diagnosis is required then consider using Dermatology Advice and Guidance initially.

Referrals can also be made to the Community Dermatology Service who can offer support, education and individual patient management plans , or to secondary care via eRS.

For advice about referrals for phototherapy, please see the section below.

Phototherapy

Phototherapy at the BRI

****STOP PRESS (24.9.21)******

Due to staff shortages and the impact of the pandemic, there is currently only a very limited capability to offer phototherapy at the BRI.

Please review the indications for phototherapy below or consider using Dermatology Advice and Guidance initially to get advice on alternative treatment options. If patients are referred to the BRI for phototherapy, they will be offered an appointment in a general Dermatology Clinic in the first instance for assessment.

Indications for phototherapy

'Patients with moderate-severe psoriasis at the onset, and those who fail to respond adequately to topical treatments should be referred for consideration of second line treatments, including phototherapy.' (from PCDS)

There is a phototherapy clinic every Tuesday at the Bristol Royal Infirmary.

If you feel a patient is suitable for phototherapy then please state this clearly in your referral and request UHB dermatology as your preferred provider. The dermatologists will triage referrals and can book patients directly into this clinic if appropriate.

The Community Dermatology Service can refer directly to this clinic if indicated.

Resources

British Association of Dermatology: http://www.Bad.org.uk/healthcare-professionals/psoriasis Information for Health Care Professionals and link to patient information leaflets and useful assessment tools.

NICE: pathways.nice.org.uk/pathways/psoriasis

Psoriasis association: http://www.psoriasis-association.org.uk/ Information for Patients on self-care and support groups/Forum

Patient support: skinsupport.org.uk/

The Psoriasis and Psoriatic Arthritis Alliance: papaa.org/

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

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