Discover what may lie ahead of you on your psoriasis journey.
Reference: NICE Clinical Guideline 153
We recommend you make an appointment to see a doctor about your psoriasis, as there is a range of treatments available that could improve your symptoms, skin and lifestyle.
To make the most of your first appointment, take a look at our guide.
Your journey on the NHS psoriasis care pathway starts with your doctor.
However, you and your symptoms are unique and your conversation with your doctor will be based upon your individual needs.
Your doctor should be assessing how severe your psoriasis is and the impact it has on your life. This typically happens when you are first diagnosed with psoriasis or if the doctor is considering referring you to a dermatology specialist – a doctor or nurse who specialises in identifying and treating skin conditions.
Here’s what you may expect from your doctor during your appointment, along with some practical tips from other people with psoriasis.
During your appointment, your doctor should provide support and information based on your needs and circumstances so that you can understand:
Please note that this support and information may be provided to you over several appointments.
When prescribing treatments your doctor should:
Fill out this questionnaire to find out. The DLQI is a questionnaire that will help you and your doctor understand how psoriasis is affecting your lifestyle.
We recommend printing and taking a copy to your appointment to give your doctor a clear picture of how psoriasis is affecting your day to day life.
It is recommended that your doctor refer you to a dermatology specialist if at any point:
You have the right to ask your doctor for a referral and you should feel comfortable doing so if you think you meet the referral criteria or if you think your current care is not going well. It is important to acknowledge when things are not going well and when specialist input may be required.
You may need immediate hospital attention if you have certain severe forms of psoriasis (such as erythrodermic and pustular psoriasis).
You have been referred to see your dermatology specialist for further assessment and treatment for your psoriasis. The dermatology specialist will work with you to assess the impact of psoriasis on your life and to design a management plan that fits with your lifestyle.
This is a great opportunity to have a positive conversation about your goals, needs and expectations.
Dermatology specialist nurses play an important role in coordinating your care. They should also support you in understanding what is available from the NHS, and let you know what information your doctor needs from you.
It is most likely that you will come into contact with a specialist nurse if you have been referred to a dermatology department in a hospital.
Nurses may be able to spend more time with you than doctors. This means that they may be able to provide additional information beyond what is shared during your appointment with your dermatologist. The specialist nurse is an important member of your healthcare team and a key point of contact for many people with psoriasis.
Forming a positive relationship with your specialist nurse is recommended. Like any relationship, this involves two-way conversation, taking the time to listen to each other’s perspectives and treating each other respectfully.
You may not have been to a hospital before, or your last visit may have been a long time ago. The environment can seem a bit overwhelming so it is worth finding out in advance what this experience may be like. Organisations like The Psoriasis Association may be able to offer help.
When you visit the dermatology department, you may be greeted by reception staff or a dermatology specialist nurse. After that, you will most likely see a dermatology specialist who will assess your psoriasis by:
Ultimately, the dermatology specialist will be aiming to understand your skin condition in the context of your lifestyle, other medical conditions and other treatments you may be taking.
Following the assessment, your dermatology specialist should discuss further treatment options with you. This should be a collaborative conversation and you should express your needs and questions at this stage.
It is recommended that your doctor refer you to a dermatology specialist if at any point:
At this point, you have probably been prescribed a cream or ointment (sometimes known as a Topical Therapy) by your doctor. NICE recommends a review after using a new Topical Therapy for 4 weeks.
Topical Therapies are applied directly to the skin. A variety of Topical Therapies are used to treat psoriasis, including creams, ointments and shampoos. They are treatments that can be prescribed by your doctor and are most likely where your treatment will begin. You are likely to discuss with your doctor what form of Topical Therapy best suits your lifestyle.
For more information about Topical Therapies, please visit The Psoriasis Association website.
Here’s what you could expect from your doctor when considering Topical Therapies.
When deciding which treatment is the most suitable for you, your doctor should take into account:
Your doctor should also:
If Topical treatment alone is unlikely to help you because your psoriasis is widespread or is affecting your nails, you may be offered additional treatments.
If you get any side effects, talk to your doctor. This includes any possible side effects not listed in the package leaflet. You can also report side effects directly via the Yellow Card Scheme at www.mhra.gov.uk/yellowcard. By reporting side effects, you can help provide more information on the safety of the treatment you are on.
When you start a new Topical treatment, you should be advised to make an appointment to go back to your doctor to check whether the treatment is meeting your needs. You should expect to have this appointment within 4-6 weeks.
At this stage you will, typically, have been using a cream or ointment (Topical Therapy) for approximately 4-6 weeks. You are now due an assessment with your doctor, who will check whether the treatment is meeting your needs.
Your doctor will assess how you are getting on with your topical treatment by:
Depending how you are getting on with your topical treatment, your doctor will advise you accordingly.
If you get any side effects, talk to your doctor. This includes any possible side effects not listed in the package leaflet. You can also report side effects directly via the Yellow Card Scheme at www.mhra.gov.uk/yellowcard. By reporting side effects, you can help provide more information on the safety of the treatment you are on.
It’s great news that you are responding well to your current treatment. Your doctor may now:
At this point, your doctor should arrange to see you at least annually to check how you are doing. However, if your psoriasis gets worse in the meantime, you should make an appointment to see your doctor.
We always recommend completing, printing and taking a copy of your DLQI to your appointment to give your doctor a clear picture of how psoriasis is affecting your day to day life.
If it’s a year since you were first given a cream or ointment (topical treatment) for your psoriasis it is important that you book your appointment with your doctor for an annual assessment.
Your doctor will assess how you are getting on with your topical treatment by:
If you get any side effects, talk to your doctor. This includes any possible side effects not listed in the package leaflet. You can also report side effects directly via the Yellow Card Scheme at www.mhra.gov.uk/yellowcard. By reporting side effects, you can help provide more information on the safety of the treatment you are on.
As a non-responder to your current cream or ointment (Topical Therapy) there are still a number of options available to your doctor at this point.
Your deoctor will probably suggest a different form of Topical Therapy. If they don’t, then they will refer you to a dermatologist to offer you more options.
If your psoriasis hasn’t improved to the level that you and your doctor have set as your target, your doctor will discuss the next treatment option with you (and your family/carer/partner where appropriate).
Before changing to an alternative treatment, your doctor will want to know that the treatment has been applied regularly, so your doctor may:
If you have tried several topical treatments and none of these have worked, your doctor should refer you to a dermatology specialist who will discuss further options with you.
If you get any side effects, talk to your doctor. This includes any possible side effects not listed in the package leaflet. You can also report side effects directly via the Yellow Card Scheme at www.mhra.gov.uk/yellowcard. By reporting side effects, you can help provide more information on the safety of the treatment you are on.
Your dermatologist will want to review your condition 3-4 months after starting a new treatment.
You have been on your tablets or capsules (also known as Oral Systemic Therapy) for 3-4 months now. At this point it is important to have an appointment with your dermatology specialist, who will check whether the treatment is meeting your needs.
You may need to arrange this appointment yourself.
Although 3-4 months is the standard time, it’s not unusual for more frequent appointments to be required.
Your dermatology specialist will assess how you are getting on with your tablets or capsules by:
Depending how you are getting on with your tablet or capsule, your dermatology specialist will advise you accordingly. According to the NICE guidelines, your treatment will be assessed as to whether it is working well or not. These assessments are based on the area of skin no longer affected by psoriasis and improvements in your quality of life.
If you get any side effects, talk to your doctor. This includes any possible side effects not listed in the package leaflet. You can also report side effects directly via the Yellow Card Scheme at www.mhra.gov.uk/yellowcard. By reporting side effects, you can help provide more information on the safety of the treatment you are on.
As a responder to a tablet or capsule, you will likely be instructed to keep taking your current treatment. Even if your condition has improved, remaining on your treatment will probably be the recommended course of action.
Even if you have shown improvement at this review, your dermatology specialist will discuss the next steps with you (and your family/carer/ partner where appropriate).
You should still be receiving on-going reviews, likely with your doctor. You may also be referred back to a dermatologist where required.
If you get any side effects, talk to your doctor. This includes any possible side effects not listed in the package leaflet. You can also report side effects directly via the Yellow Card Scheme at www.mhra.gov.uk/yellowcard. By reporting side effects, you can help provide more information on the safety of the treatment you are on.
If your tablet or capsule (Oral Systemic Therapy) has failed to make the improvements you seek, you may be offered a different tablet or capsule. Alternatively, you may be offered Injectable Therapy.
Injectables (sometimes known as Injectable Systemic Therapy) are given by injection into the skin or via a drip into a vein. These treatments modify the body's immune - or natural defence - system. Psoriasis is partly caused by a problem with the immune system.
For more information about injectable therapies, visit The Psoriasis Association website.
If your psoriasis hasn’t improved to the level that you and your dermatology specialist have set as your target, your dermatology specialist will discuss the next treatment option with you (and your family/ carer/partner where appropriate).
When deciding which treatment is the most suitable for you, your dermatology specialist should take into account:
As well as injectable therapy, you may be receiving additional treatments.
Your dermatology specialist should explain the risks and side effects, as well as the benefits, associated with your therapy and how to take your medication safely.
If you get any side effects, talk to your doctor. This includes any possible side effects not listed in the package leaflet. You can also report side effects directly via the Yellow Card Scheme at www.mhra.gov.uk/yellowcard. By reporting side effects, you can help provide more information on the safety of the treatment you are on.
Your dermatologist will want to review your condition after 3-4 months.
As a non-responder to your current tablet or capsule there are still a number of options available to your dermatologist at this point.
Your dermatologist may recommend a different type of tablet or capsule or an alternative form of treatment.
If your psoriasis hasn’t improved to the level that you and your dermatology specialist have set as your target, your dermatology specialist will discuss the next treatment option with you (and your family/ carer/partner where appropriate).
Your care doesn’t end here. Your dermatology specialist and doctor will talk about other therapies available to you.
If you get any side effects, talk to your doctor. This includes any possible side effects not listed in the package leaflet. You can also report side effects directly via the Yellow Card Scheme at www.mhra.gov.uk/yellowcard. By reporting side effects, you can help provide more information on the safety of the treatment you are on.
You have been receiving injectable therapy for a period of time and your dermatology team will carry out a review appointment with you to see how you are responding and to check whether the treatment is meeting your needs.
The exact nature of the review appointment will depend on your personal history and the injectable therapy you have been prescribed. The dermatology team is likely to:
Depending how you are getting on with your therapy, your dermatology specialist will advise you accordingly. According to the NICE guidelines, your treatment will be assessed as to whether it is working well or not. These assessments are based on the area of skin no longer affected by psoriasis and improvements in your quality of life.
We recommend completing, printing and taking a copy of the DLQI to your appointment to give your doctor a clear picture of how psoriasis is affecting your day to day life.
If you get any side effects, talk to your doctor. This includes any possible side effects not listed in the package leaflet. You can also report side effects directly via the Yellow Card Scheme at www.mhra.gov.uk/yellowcard. By reporting side effects, you can help provide more information on the safety of the treatment you are on.
As a responder to injectable therapy, you will probably be instructed to keep taking your treatment. Even if your condition has improved, remaining on your treatment is still the recommended course of action.
It is recommended that you ask your dermatologist to arrange a 6-12 month review to ensure your treatment is still working as intended.
Even if you have shown improvement at this review, your dermatology specialist will discuss the next steps with you (and your family/carer/partner where appropriate).
If you get any side effects, talk to your doctor. This includes any possible side effects not listed in the package leaflet. You can also report side effects directly via the Yellow Card Scheme at www.mhra.gov.uk/yellowcard. By reporting side effects, you can help provide more information on the safety of the treatment you are on.
As a non-responder to your current injectable therapy there are still a number of options available to your dermatologist at this point.
Your dermatologist will likely suggest a different form of injectable therapy. You may need to try several therapies.
If your psoriasis hasn’t improved to the level that you and your dermatology specialist have set as your target, your dermatology specialist will discuss the next treatment option with you (and your family/ carer/partner where appropriate).
Your care doesn’t end here. Your dermatology specialist and doctor will talk about other therapies available to you.
If you get any side effects, talk to your doctor. This includes any possible side effects not listed in the package leaflet. You can also report side effects directly via the Yellow Card Scheme at www.mhra.gov.uk/yellowcard. By reporting side effects, you can help provide more information on the safety of the treatment you are on.
Oral Systemic Therapy is medication taken in the form of a tablet or capsule, affecting the whole body.
For more information about oral systemic therapy, visit The Psoriasis Association website.
If your psoriasis hasn’t improved to the level that you and your dermatology specialist have set as your target, your dermatology specialist will discuss the next treatment option with you (and your family/ carer/partner where appropriate).
When deciding which treatment is the most suitable for you, your dermatology specialist should take into account:
As well as Oral Systemic Therapy, you may be receiving additional treatments.
Your dermatology specialist should explain the risks and side effects, as well as the benefits, associated with your therapy and how to take your medication safely.
If you get any side effects, talk to your doctor. This includes any possible side effects not listed in the package leaflet. You can also report side effects directly via the Yellow Card Scheme at www.mhra.gov.uk/yellowcard. By reporting side effects, you can help provide more information on the safety of the treatment you are on.
Your dermatologist should assess your condition regularly.
Phototherapy is the use of ultraviolet (UV) light to slow the rapid growth of new skin cells.
There are three types of ultraviolet light therapy; psoralen plus ultraviolet A (PUVA), narrowband ultraviolet B (UVB) or broadband UVB.
For more information about Phototherapy, visit The Psoriasis Association website.
Your dermatology specialist may prescribe Phototherapy if:
Phototherapy treatment is given 2-3 times a week, usually in a hospital. Your dermatology specialist should offer you alternative treatment if:
Your dermatology specialist will assess how you are getting on with your Phototherapy at regular points by:
As well as Phototherapy, you may be receiving additional treatments. Depending how you are getting on with your Phototherapy, your dermatology specialist will advise you accordingly.
If you get any side effects, talk to your dermatology specialist. This includes any possible side effects not listed in the package leaflet. You can also report side effects directly via the Yellow Card Scheme at www.mhra.gov.uk/yellowcard. By reporting side effects, you can help provide more information on the safety of the treatment you are on.
Your dermatologist will usually review your response to Phototherapy after an agreed time frame.
Depending on the advice you were given by your dermatologist, you may need to book this appointment yourself.
If your psoriasis hasn’t improved to the level that you and your dermatology specialist have set as your target at this review, your dermatology specialist will discuss the next treatment option with you (and your family/carer/partner where appropriate).
If you get any side effects, talk to your dermatology specialist. This includes any possible side effects not listed in the package leaflet. You can also report side effects directly via the Yellow Card Scheme at www.mhra.gov.uk/yellowcard. By reporting side effects, you can help provide more information on the safety of the treatment you are on.
Even if your treatment has worked, your dermatology specialist will discuss the next steps with you (and your family/carer/ partner where appropriate).
If you get any side effects, talk to your dermatology specialist. This includes any possible side effects not listed in the package leaflet. You can also report side effects directly via the Yellow Card Scheme at www.mhra.gov.uk/yellowcard. By reporting side effects, you can help provide more information on the safety of the treatment you are on.
As a non-responder to Phototherapy there are still a number of options available to your dermatologist at this point.
Depending how you are getting on with your Phototherapy, your dermatology specialist will advise you accordingly.
If your psoriasis hasn’t improved to the level that you and your dermatology specialist have set as your target at this review, your dermatology specialist will discuss the next treatment option with you (and your family/carer/partner where appropriate).
If you get any side effects, talk to your dermatology specialist. This includes any possible side effects not listed in the package leaflet. You can also report side effects directly via the Yellow Card Scheme at www.mhra.gov.uk/yellowcard. By reporting side effects, you can help provide more information on the safety of the treatment you are on.
PSO18-C007 April 2018
We know your experience of psoriasis is highly individual and the NHS can seem large, daunting and a bit of a roller coaster at times. So we felt it was important for you to know where you start, where you stand and where you might go with the NHS at different points in your psoriasis care.
Here's Laura, one of our group of people with psoriasis who helped create this site, to share her experiences of care through the NHS care pathway. Pathway is a term the NHS uses to describe the different stages of care and the healthcare professionals you may see, when and why.
You can find out more about the NHS Psoriasis Care Pathway, How the NHS Works and the Standards of Care you can expect to receive under the tabs below.
When you're treated by the NHS you have rights and are entitled to a certain standard of care. By understanding what these standards are, you can strive towards this.
Organisations, like the NHS and the National Institute for Health and Care Excellence (NICE), have set out what you should expect from your care experience.
There are also a number of standards that you can expect from your care that specifically relate to psoriasis, as set out by NICE and you can read them here. They state that adults with psoriasis should be:
These standards can help you to gain a greater sense of control of your psoriasis. If you think your care is not meeting these standards, speak to your healthcare professional or you can follow the NHS complaints procedure here.
It’s important to remember that care is a two-way relationship between patients and healthcare professionals, and both parties have a responsibility to work together respectfully.
Find this helpful? Share this page and help others also suffering from psoriasis.
Although the NHS is set up to provide people with local and responsive care, we know it can sometimes seem large and daunting. In fact, when asked to describe experiences within the NHS, we sometimes hear descriptions like, 'life on a rollercoaster' or 'being trapped in a maze.'
These descriptions reflect a common concern in the care and treatment of psoriasis sufferers – that it can seem disjointed, hard to access and unpredictable.
However, as said above, the NHS is run in a way that aims to put people at the centre of their care. By understanding what you should expect during your care, you can have balanced conversations and seek the support you need.
The Government has designed the NHS like this so that it is responsive to the needs of local communities.
It can mean that the way care is experienced varies across the UK. In addition, healthcare professionals such as GPs, dermatologists and specialist nurses will all practice in slightly different ways. This means that there is not a "one size fits all" approach for healthcare in the UK.
The level of care given to people with psoriasis varies across the country. Some report full satisfaction, whilst others report they experience long waiting times once referrals have been secured; or that appointments with specialists are too brief.
Challenges relating to providing healthcare can be complex. People with psoriasis can get more from their care by gaining information, understanding their rights, and understanding the type of conversations that help healthcare professionals provide tailored care.
Find this helpful? Share this page and help others also suffering from psoriasis.
Here are a selection of tools to help you make the most of your time with your doctor.
Find out how
Help your doctor to help you by understanding how psoriasis impacts your quality of life.
Begin now
Monitor, measure and track your psoriasis symptoms to put you and your doctor in command.
Take control
Go straight to the NHS Dermatologist Location Finder and pop in your postcode
PSO17-C014g September 2017
