Assessment and referral

If you have psoriasis, an assessment should be carried out to find out:

  • the severity of your psoriasis and the impact it has on your physical, psychological and social wellbeing

  • if you have psoriatic arthritis

  • if you have any other related conditions.

Assessment of psoriasis and referral

The severity and impact of your psoriasis should be assessed:

  • when you first see a healthcare professional

  • before you are referred to a specialist or for a new treatment

  • to check whether any treatments you are having are helping.

Your healthcare professional should record:

  • how severely your skin is affected (using a tool called the static Physicians' Global assessment to rate the skin from clear to very severe)

  • what percentage of your body surface is affected

  • how bad you feel your psoriasis is – you may be asked to use a tool called the static Patient's Global Assessment to rate your skin on a scale from 'clear' to 'very severe'

  • whether your nails are affected or you have psoriasis on parts of your body that are particularly visible or difficult to treat (such as the face, scalp, palms, soles, body creases [called flexures], and genitals)

  • whether the psoriasis is causing more serious illness if you have erythroderma or generalised pustular psoriasis

  • how your everyday life is affected by psoriasis (for example, if it causes embarrassment or affects your participation in social or physical activities, employment or education)

  • how you are coping with the condition and any treatment, if your psoriasis is causing you any distress and if you need any further help

  • if your psoriasis has a big impact on your mood (for example, if it makes you feel down or anxious).

If your healthcare professional uses a tool to assess your psoriasis they should use one that takes into account your age, any disabilities or language and communication difficulties you might have. They should also be aware that if you have dark skin, it may make it more difficult to measure any redness.

They should also ask you how your psoriasis is affecting your family or carers. Your healthcare professional should always ask you questions in a way that is appropriate for your age.

At the same time, your healthcare professional should also assess whether you are depressed and offer advice and support for depression if needed.

If you are a child or young person you should be offered a referral to a specialist when you first see a healthcare professional with symptoms of psoriasis.

If you are an adult having an assessment you should be offered referral for advice from a dermatologist if:

  • your diagnosis is uncertain when you first see your healthcare professional

  • your psoriasis is severe, widespread or has a big impact on your physical, psychological or social wellbeing

  • your psoriasis is not improving with topical treatments

  • you have acute guttate psoriasis that needs treating with phototherapy

  • you have nail psoriasis that has a big impact on using your hands or your appearance.

If you have generalised pustular psoriasis or erythroderma you should be referred to a specialist immediately.

Assessment and referral for psoriatic arthritis

You should be offered an annual assessment to find out if you have a type of joint disease associated with psoriasis, called psoriatic arthritis. This should be done in the first 10 years after your psoriasis starts.

If your healthcare professional suspects you may have psoriatic arthritis you should be referred to a rheumatologist for further assessment and advice on planning your care.

Assessment for other related conditions

People with psoriasis, especially those with severe psoriasis, may be at increased risk of related conditions such as heart disease and deep vein thrombosis.

Your healthcare professional should explain the risks and give you advice and information on how to reduce the risks of related conditions and make healthy lifestyle changes.

If you have severe psoriasis you should be offered an assessment of your risk of cardiovascular disease when you first see your healthcare professional and then at least every 5 years.

  • Information Standard