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Explore the ways the NHS treats psoriasis

Discover what may lie ahead of you on your psoriasis journey.

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Reference: NICE Clinical Guideline 153

Have you seen a doctor to discuss your psoriasis?

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.

Our guide to your first appointment

What to expect

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.

What your doctor will do

During your appointment, your doctor should provide support and information based on your needs and circumstances so that you can understand:

  • Your diagnosis and treatment options
  • Factors that could impact your lifestyle
  • When and how to treat your psoriasis
  • How to use any prescribed medicines safely and effectively
  • When and how to seek further review; or
  • How to manage the impact of psoriasis on your life (physically, mentally and socially).

Please note that this support and information may be provided to you over several appointments.

When prescribing treatments your doctor should:

  • Ensure that a treatment plan is developed to meet your personal health goals and minimise the impact of psoriasis
  • Take into account your age and circumstances related to your psoriasis (such as treatment history, type of psoriasis, impact of psoriasis, how severe your psoriasis is, etc.)
  • Discuss the risks and benefits of treatment options
  • Discuss the importance of using your treatment as prescribed for the best outcomes.

How is psoriasis affecting your life on a daily basis?

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.

Should you request a referral to a dermatologist?

It is recommended that your doctor refer you to a dermatology specialist if at any point:

  • They are unsure if you have psoriasis
  • You have severe psoriasis; or
  • Your psoriasis covers large areas of your body, i.e. more than 10% of the body surface area is affected (the palm of your hand represents around 1% of your body surface area)
  • You have any type of psoriasis that is not responding well to treatment with creams, ointments and shampoos
  • Your nails are affected by your psoriasis and impact your life either cosmetically or practically
  • You have acute guttate psoriasis (also known as ‘tear drop’ or ‘rain drop’ psoriasis; a generalised rash of small spots) that requires Phototherapy
  • Your psoriasis is having an impact on your life (physically, mentally and socially). For example, you are no longer able to work or you feel depressed. In this case, you might feel that you need psychological help. Take the DLQI questionnaire to assist your doctor in understanding the impact psoriasis is having on your life.

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).

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Has your doctor referred you to a dermatologist to assess your psoriasis and its symptoms?

Which therapy did your dermatologist most recently suggest?

What you should know

Your dermatologist

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.

Specialist Nurses

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.

What should your dermatology team do?

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:

  • Examining you to see how severe your psoriasis is, how much of your body is affected and where your psoriasis is
  • Asking you about the impact psoriasis has on your life (physically, mentally and socially)
  • Asking you about your experience with your creams or ointments.

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.

Referral criteria to the dermatology department

It is recommended that your doctor refer you to a dermatology specialist if at any point:

  • They are unsure if you have psoriasis
  • You have severe psoriasis; or
  • Your psoriasis covers large areas of your body, i.e. more than 10% of the body surface area is affected (the palm of your hand represents around 1% of your body surface area)
  • You have any type of psoriasis that is not responding well to treatment with creams, ointments and shampoos
  • Your nails are affected by your psoriasis and impact your life either cosmetically or practically
  • You have acute guttate psoriasis (also known as ‘tear drop’ or ‘rain drop’ psoriasis; a generalised rash of small spots) that requires Phototherapy
  • Your psoriasis is having an impact on your life (physically, mentally and socially). For example, you are no longer able to work or you feel depressed. In this case, you might feel that you need psychological help. Take our questionnaire to assist your doctor in understanding the impact psoriasis is having on your life.
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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.

Have you seen your doctor since?

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What to expect from your doctor

Creams and ointments (Topical Therapy)

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.

What will your doctor do?

When deciding which treatment is the most suitable for you, your doctor should take into account:

  • Any preferences you have
  • Whether the treatment is acceptable to you in terms of physical appearance when applied to the skin
  • Whether there might be any practical problems with applying the treatment
  • Where and how widespread your psoriasis is.

Your doctor should also:

  • Discuss with you the different forms of treatment available and explain which might be best suited to you depending on your preferences. It is possible that you could be given more than one product to use on different parts of your body
  • Provide you with practical help and advice on how to use your treatment. If you have a physical disability or visual impairment that might affect your ability to apply a topical medication then you and/or your family or carers should be offered additional advice and support specific to your particular needs.

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.

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How did your psoriasis respond to the cream or ointment?

Your review

What to expect

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.

What can you do to prepare for your appointment

  • Complete the DLQI and take your answers with you. The DLQI is a questionnaire that will help you and your doctor understand how psoriasis is affecting your lifestyle.
  • Think about any questions you’d like to ask your doctor.
  • Write a list of things you’d like to discuss, such as what you would like to achieve through care, and the physical and emotional impact psoriasis might be having on your life.
  • Rehearse what you want to say so you can get as much help as possible during your appointment.

What will your doctor do?

Your doctor will assess how you are getting on with your topical treatment by:

  • Measuring how severe your psoriasis is and how much of your body is affected, compared to your last visit
  • Measuring the impact psoriasis has on your life (physically, mentally and socially)
  • Asking you about any side effects you might have experienced.

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.

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Responded Moderately to well

If your treatment has worked

It’s great news that you are responding well to your current treatment. Your doctor may now:

  • Emphasise the importance of continuing treatment until a satisfactory outcome is achieved (for example clear or nearly clear skin) as appropriate
  • Remind you that relapses occur for most people after treatment is stopped
  • Advise on how to use and for how long to use your prescribed topical treatments.

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.

What to expect at your annual review

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.

What can you do to prepare for your appointment

  • Complete the DLQI and take your answers with you. The DLQI is a questionnaire that will help you and your doctor understand how psoriasis is affecting your lifestyle.
  • Think about any questions you’d like to ask your doctor.
  • Write a list of things you’d like to discuss, such as what you would like to achieve through care, and the physical and emotional impact psoriasis might be having on your life.
  • Rehearse what you want to say so you can get as much help as possible during your appointment.

Your doctor will assess how you are getting on with your topical treatment by:

  • Measuring how severe your psoriasis is and how much of your body is affected compared to your last visit
  • Measuring the impact psoriasis has on your life (physically, mentally and socially)
  • Asking you about any side effects that you might have experienced.

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.

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Little to no improvement

So your treatment didn't work

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.

What can you do to prepare for your appointment

  • Complete the DLQI and take your answers with you. The DLQI is a questionnaire that will help you and your doctor understand how psoriasis is affecting your lifestyle.
  • Think about any questions you’d like to ask your doctor.
  • Write a list of things you’d like to discuss, such as what you would like to achieve through care, and the physical and emotional impact psoriasis might be having on your life.
  • Rehearse what you want to say so you can get as much help as possible during your appointment. View our 'appointment in practise' interactive video here.

What will your doctor do?

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:

  • Discuss with you whether you have had any difficulties with applying the treatment, whether its appearance when applied to your skin is acceptable to you or how well you get on with the treatment and, where relevant, offer an alternative form
  • Consider other possible reasons for difficulties in using your treatment, such as confusion about how and when to use the treatment, fear and anxiety about it or lifestyle difficulties etc.

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.

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Your dermatologist will want to review your condition 3-4 months after starting a new treatment.

Have you been back for your review?

How has your psoriasis responded?

Your 3-4 month review

What to expect

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.

What should your dermatology team do?

Your dermatology specialist will assess how you are getting on with your tablets or capsules by:

  • Measuring how severe your psoriasis is and how much of your body is affected, compared to your last visit
  • Measuring the impact psoriasis has on your life (physically, mentally and socially)
  • Asking you about any side effects you might have experienced.
  • Asking you (and your family or carers where appropriate) views on the treatment.

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.

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Responded moderately to well

If your treatment has worked

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.

What should your dermatology team do?

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.

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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.

Have you been offered injectable therapy?

What to Expect

Injectable Therapies

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.

What should your dermatology team do?

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:

  • Your age
  • Your previous treatment history
  • How severe your psoriasis is and the impact psoriasis has on your life
  • If you have psoriatic arthritis (in consultation with a rheumatologist)
  • If you are planning a pregnancy
  • If you have other health problems
  • Your personal views such as your treatment goals, your preference on injection type or how many injections you might need to have.

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.

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Your dermatologist will want to review your condition after 3-4 months.

Have you been back for your review?

Back

Little to no improvement

So, your treatment didn't work

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.

What can you do to prepare for your appointment

  • Complete the DLQI and take your answers with you. The DLQI is a questionnaire that will help you and your doctor understand how psoriasis is affecting your lifestyle.
  • Think about any questions you’d like to ask your doctor.
  • Write a list of things you’d like to discuss, such as what you would like to achieve through care, and the physical and emotional impact psoriasis might be having on your life.
  • Rehearse what you want to say so you can get as much help as possible during your appointment.

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.

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How has your psoriasis responded in the agreed time period?

Back

Your 3-4 month review

What to expect

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.

What can you do to prepare for your appointment

  • Complete the DLQI and take your answers with you. The DLQI is a questionnaire that will help you and your doctor understand how psoriasis is affecting your lifestyle.
  • Think about any questions you’d like to ask your doctor.
  • Write a list of things you’d like to discuss, such as what you would like to achieve through care, and the physical and emotional impact psoriasis might be having on your life.
  • Rehearse what you want to say so you can get as much help as possible during your appointment.

What should your dermatology team do?

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:

  • Explore how severe your psoriasis is and how much of your body is affected, compared to your last visit
  • Ask you about any side effects you might have experienced.
  • Depending on the treatment you are prescribed, check whether you are happy with the self-injection process or, alternatively, injections may take place at the hospital.
  • Discuss the impact psoriasis has on your life (physically, mentally and socially).

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.

Fill out our dermatology life quality index (DLQI)

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.

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Responded Moderately to well

If your treatment has worked

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.

What should your dermatology team do?

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.

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Little to no improvement

So, your treatment didn't work

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.

What happens next?

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.

What can you do to prepare for your appointment

  • Complete the DLQI and take your answers with you. The DLQI is a questionnaire that will help you and your doctor understand how psoriasis is affecting your lifestyle.
  • Think about any questions you’d like to ask your doctor.
  • Write a list of things you’d like to discuss, such as what you would like to achieve through care, and the physical and emotional impact psoriasis might be having on your life.
  • Rehearse what you want to say so you can get as much help as possible during your appointment.
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What to expect

Tablets & Capsules (Oral Systemic Therapy)

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.

What should your dermatology team do?

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:

  • Your age
  • Your previous treatment history
  • How severe your psoriasis is and the impact psoriasis has on your life
  • If you have psoriatic arthritis (in consultation with a rheumatologist)
  • If you are planning a pregnancy
  • If you have other health problems
  • Your personal views such as your treatment goals, your preference on injection type or how many injections you might need to have.

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.

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Your dermatologist should assess your condition regularly.

Have you had a review?

What to expect

Phototherapy

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.

What should your dermatology team do?

Your dermatology specialist may prescribe Phototherapy if:

  • You have plaque or guttate psoriasis that cannot be controlled by treatment with creams and shampoos
  • You have pustular psoriasis.

Phototherapy treatment is given 2-3 times a week, usually in a hospital. Your dermatology specialist should offer you alternative treatment if:

  • Your body is not responding well to the treatment
  • You experienced a rapid relapse following completion of the treatment (rapid relapse is defined as greater than 50% of baseline disease severity within 3 months)
  • You are having difficulty accessing the treatment due to issues with travelling to the centre, or taking time off work.
  • You are at a high risk of skin cancer.

Your dermatology specialist will assess how you are getting on with your Phototherapy at regular points by:

  • Measuring how severe your psoriasis is and how much of your body is affected compared to your last visit
  • Measuring the impact psoriasis has on your life (physically, mentally and socially)

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.

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How has your psoriasis responded to the phototherapy after the agreed time frame?

Back

Your phototherapy review

What to expect

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.

What should your dermatology team do

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.

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Responded moderately to well

What should your dermatology team do

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.

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Little to no improvement

So your treatment didn't work

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.

What can you do to prepare for your appointment

  • Complete the DLQI and take your answers with you. The DLQI is a questionnaire that will help you and your doctor understand how psoriasis is affecting your lifestyle.
  • Think about any questions you’d like to ask your doctor.
  • Write a list of things you’d like to discuss, such as what you would like to achieve through care, and the physical and emotional impact psoriasis might be having on your life.
  • Rehearse what you want to say so you can get as much help as possible during your appointment.

What should your dermatology team do?

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.

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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.

Standards of Care


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:

  • Offered an assessment of disease severity at diagnosis and when response to treatment is assessed
  • Offered an assessment of the impact of the disease on physical, psychological and social wellbeing at diagnosis and when response to treatment is assessed
  • Referred for assessment by a dermatology specialist if indicated
  • Offered a cardiovascular risk assessment at diagnosis and at least once every five years
  • Offered an annual assessment for psoriatic arthritis, if receiving treatment
  • Monitored in accordance with locally agreed protocols, if receiving systemic therapy

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.

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How the NHS works


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.

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Enhance Your Appointment


You're the expert on you

Here are a selection of tools to help you make the most of your time with your doctor.

Find out how

Take your first step


Complete a DLQI

Help your doctor to help you by understanding how psoriasis impacts your quality of life.

Begin now

Knowledge is power


The SymTrac™ App

Monitor, measure and track your psoriasis symptoms to put you and your doctor in command.

Take control

Find your nearest dermatologist

Go straight to the NHS Dermatologist Location Finder and pop in your postcode

PSO17-C014g September 2017