Psoriasis

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Affects around 3% of the population
It is uncommon in certain populations such as oriental people, native American Indians and West Africans
Both sexes are equally affected
Mild to moderate psoriasis can usually be managed in primary care
Psoriasis may worsen (sometimes months after) the introduction of some drugs e.g. Beta-blockers, NSAIDs, ACE inhibitors
Remember it is an independent risk factor for cardiovascular disease/cancer/anxiety and depression
Adherence to treatment is low and only just over 50% even in clinical trials – try to consider cosmetic acceptability, side effect profiles, formulation and practicalities of application

Referral Criteria:

Suggested referral of psoriasis to secondary care:

If diagnosis uncertain
If too widespread to make treatment by patient at home practical
Failure of topical treatments including calcipotriol / betamethasone diporopionate foam if appropriate (not appropriate for face/flexures)

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Skin

Psoriasis may develop at any age although it most frequently presents in young adults as well as in the sixth and seventh decades
It is generally asymptomatic although some patients experience itch

Psoriatic arthropathy

Recent studies suggest that the prevalence of psoriatic arthritis in patients with psoriasis may be up to 30%
There is a strong link with nail disease
All patients with psoriasis should be assessed for psoriatic arthropathy as early intervention can reduce joint damage, refer to related chapter on Psoriatic arthritis for more information

Clinical findings

Morphology

Most cases of chronic plaque psoriasis are described as large plaque psoriasis or small plaque psoriasis
Plaques are ruby-red, and well-defined with a silvery surface scale. The plaques can join together to involve very extensive areas of the skin particularly on the trunk and limbs
Auspitz sign - when adherent psoriatic scales are scraped or picked off pinpoint bleeding, known as the Auspitz sign, may occur from capillaries which undulate vertically throughout the thickened psoriatic skin
Lesions on lower legs may be less typical

Suggested referral of psoriasis to secondary care:

if diagnosis uncertain
if too widespread to make treatment by patient at home practical
Failure of topical treatments including calcipotriol / betamethasone diporopionate foam if appropriate (not appropriate for face/flexures)

Treatments available in hospital:

e-Referrals Service selection:

This guideline has been signed off on behalf of NHS Devon.

Publication date: August 2017

Referral