Psoriasis

Structure

Evidence of local arrangements for people with psoriasis to receive an assessment of disease severity at diagnosis and when response to treatment is assessed.

Data source: Local data collection.

Process

a) Proportion of people with psoriasis who receive an assessment of disease severity at diagnosis.

Numerator – the number of people in the denominator who receive an assessment of disease severity at diagnosis.

Denominator – the number of people with psoriasis.

Data source: Local data collection.

b) Proportion of people with psoriasis who receive an assessment of disease severity when response to treatment is assessed.

Numerator – the number of people in the denominator who receive an assessment of disease severity when response to treatment is assessed.

Denominator – the number of people with psoriasis receiving treatment.

Data source: Local data collection.

Assessment

The severity of the disease should be assessed at first presentation and to evaluate the efficacy of interventions. It should also be assessed before referral for specialist advice and at each referral point in the treatment pathway.

The assessment includes recording the body surface area affected, any involvement of nails, high-impact and difficult-to-treat sites (for example, the face, scalp, palms, soles, flexures and genitals) and any systemic upset such as fever and malaise, which are common in unstable forms of psoriasis, such as erythroderma or generalised pustular psoriasis.

The Physician's Global Assessment and Patient's Global Assessment tools can be used to support assessment of disease severity. In specialist settings, the Psoriasis Area and Severity Index and Nail Psoriasis Severity Index can also be used.

Response to treatment

Response to treatment should be evaluated by an assessment of disease severity at a time appropriate to the treatment. NICE guidance recommends the following timeframes: