Assessment and management of psoriasis: summary of NICE guidanceBMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e6712 (Published 24 October 2012) Cite this as: BMJ 2012;345:e6712
- Eleanor Samarasekera, research fellow1,
- Laura Sawyer, senior health economist1,
- Jill Parnham, operations director1,
- Catherine H Smith, consultant dermatologist and senior lecturer2
- on behalf of the Guideline Development Group
- 1National Clinical Guideline Centre, Royal College of Physicians of London, London NW1 4LE, UK
- 2St John’s Institute of Dermatology, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
- Correspondence to: C H Smith
Psoriasis is a common inflammatory skin condition affecting about 1.3–2.2% of the UK population1 and may be associated with psoriatic arthritis.2 People with psoriasis, especially those with severe disease, are also at increased risk of cardiovascular disease,3 diabetes,4 and depression.5 Psoriasis may result in functional, psychological, and social morbidity, even in people with minimal involvement (less than the equivalent of three palm areas). However, doctors, including dermatologists, often fail to appreciate the extent of this disability,6 and many people with psoriasis are dissatisfied with their treatment.6 Yet, highly effective and cost effective treatments are available, and improving outcomes therefore requires better assessment and management of psoriasis, including its impact on a patient’s wellbeing, by healthcare professionals. This article summarises the most recent recommendations from the National Institute for Health and Clinical Excellence (NICE) on the management of psoriasis.7
NICE recommendations are based on systematic reviews of the best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets.
Principles of care
Provide a single point of contact for people with all types of psoriasis (and their families or carers) to aid access to appropriate information and advice about the condition and the services available at each stage of the care pathway.
[Based on the experience and opinion of the Guideline Development Group (GDG)]
Assessment of disease severity and impact, and when to refer for specialist care
Assess the severity and impact of any type of psoriasis:
-At first presentation
-Before referral for specialist advice and at each referral point in the treatment pathway
-To evaluate the efficacy of interventions.
[Based on the experience and opinion of the GDG]
When assessing the disease severity in any healthcare setting, …