Indications for referral of a patient with psoriasis to a dermatologist:
(1) uncertainty about the diagnosis (see differential diagnosis below)
(2) severe disability, resulting in excessive time off work or inability to work
(3) failure to respond to an accepted topical therapy after 3 months of appropriate use
(4) involvement of locations that are difficult to treat (face, scalp, genitals, palms, soles of feet) if unresponsive to initial therapy
(5) need for hospital admission
(6) complications from topical therapy
(7) need for specialized therapy (phototherapy, systemic therapy, use of targeted therapy)
An urgent referral may be required if the patient has:
(1) acute unstable psoriasis
(2) erythrodermic psoriasis
(3) generalized pustular psoriasis
Differential diagnosis of psoriasis:
(1) mycosis fungoides, Sezary syndrome
(2) discoid lupus
(3) tinea
(4) seborrheic dermatitis
(5) syphilis
(6) contact dermatitis
(7) candidiasis
(8) drug eruption
(9) pityriasis rosea
(10) eczema
