Psoriasis
Red flags
Consider urgent referral for patients with the following
- Erythoderma
- Extensive pustular flare up
- Flare associated with fever
Features that may lead to more urgent categorisation
- Extensive skin involvement
- Previous erythroderma
- Poor control despite rational management plan
- Associated severe joint involvement (consider rheumatology referral)
Psoriasis is a chronic autoimmune related skin condition characterised by areas of inflamed hyperkeratotic skin with fine silvery scale surrounded by normal skin. It is more commonly found on extensor surfaces of limbs and overlying the spine especially the sacrum. There are various forms:
- Chronic stable plaque psoriasis
- Guttate psoriasis
- Inverse psoriasis
- Pustular psoriasis
- Erythrodermic
Pustular and erythrodermic psoriasis are serious conditions and often require hospitalisation.
There is no cure and the condition is lifelong but the patient can undergo periods of remission. In a proportion of cases nails and joints can be affected leading to an inflammatory joint disease that can affect small and large joints as well as the axial skeleton.
Most cases can be managed adequately in primary care but specialist intervention may be required for managing acute flare ups and the articular manifestations. A range of treatments can be offered including:
- Topical therapy
- Ultraviolet light therapy (PUV)
- Immunosuppressant drug therapy (methotrexate, azathioprine, cyclophosphamide)
- Biological therapies
Other important information for referring practitioners
Lifestyle changes
- Promote healthy lifestyle
- Reduce or stop smoking
- Reduce stress
Medical management
This depends on the type of psoriasis and severity
- Chronic plaque psoriasis
Referral requirements
A referral may be rejected without the following information.
- Presence of any Red Flags
- Reason for referral i.e. management assistance, PUVA therapy, immunosuppression, biological therapy.
- Relevant clinical history
- Description of distribution
- Sites affected with severity
- Treatments trialled and reasons for failure
- Detailed medication history including any allergy
- If seen previously by Dermatologist include last two letters
- Family history if relevant
- Any relevant histology
Out of catchment
Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.
- Impact on employment
- Impact on education
- Impact on home
- Impact on activities of daily living
- Impact on ability to care for others
- Impact on personal frailty or safety
- Identifies as Aboriginal and/or Torres Strait Islander
- To establish a diagnosis
- For treatment or intervention
- For advice and management
- For specialist to take over management
- Reassurance for GP/second opinion
- For a specified test/investigation the GP can’t order, or the patient can’t afford or access
- Reassurance for the patient/family
- For other reason (e.g. rapidly accelerating disease progression)
- Clinical judgement indicates a referral for specialist review is necessary
- Presenting symptoms (evolution and duration)
- Physical findings
- Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
- Body mass index (BMI)
- Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
- Current medications and dosages
- Drug allergies
- Alcohol, tobacco and other drugs use
- Full name (including aliases)
- Date of birth
- Residential and postal address
- Telephone contact number/s – home, mobile and alternative
- Medicare number (where eligible)
- Name of the parent or caregiver (if appropriate)
- Preferred language and interpreter requirements
- Identifies as Aboriginal and/or Torres Strait Islander
- Full name
- Full address
- Contact details – telephone, fax, email
- Provider number
- Date of referral
- Signature
- Willingness to have surgery (where surgery is a likely intervention)
- Choice to be treated as a public or private patient
- Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)
Send referral
Hotline: 1300 364 938
Medical Objects ID: MQ40290004P
HealthLink EDI: qldmnhhs
Mail:
Metro North Central Patient Intake
Aspley Community Centre
776 Zillmere Road
ASPLEY QLD 4034
Health pathways
Access to Health Pathways is free for clinicians in Metro North Brisbane.
For login details email:
healthpathways
Login to Brisbane North Health Pathways:
brisbanenorth.