Referral to emergency

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

  • generalised pustular psoriasis
  • erythrodermic psoriasis, greater than 90% body surface area

Please contact the on-call registrar to discuss your concerns prior to referral.

For clinical advice, please telephone the relevant specialty service.

Northern Adelaide Local Health Network 

Southern Adelaide Local Health Network

  • Flinders Medical Centre (08) 8204 5511, after hours on-call service for patients of all ages until 11:00 pm

Women’s and Children’s Hospital Network


Inclusions

  • widespread psoriasis
  • diagnostic clarification
  • psoriasis causing significant distress or if interfering with childcare/school
  • psoriasis requiring management with narrow band ultraviolet B (nbUVB) or systemic treatment, (oral and injectables

Exclusions

  • localised disease without trial first line management; two topical agents liberally for four weeks each then as required
  • psoriatic arthritis, refer to rheumatology

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • severe and widespread psoriasis
  • pustular psoriasis - localised disease

Category 2 (appointment clinically indicated within 90 days)

  • widespread disease with inadequate response to first line topical management and requires specialist assessment for consideration of nbUVB and systemic management

Category 3 (appointment clinically indicated within 365 days)

  • limited disease with inadequate response to first line topical management and requires specialist assessment for consideration of nbUVB and systemic management

Additional information to assist triage categorisation

  • colour photograph/s of lesion/s where appropriate to demonstrate severity/extent of disease
  • whether there is coexisting joint disease
  • whether there are systemic symptoms

Clinical management advice

General

  • psoriasis is associated with the metabolic syndrome. Consider screening for these comorbidities (blood pressure, Hba1c, Raised fasting lipids, BMI) in established disease, especially in teenage patients.
  • emollients/moisturisers can help maintain the skin barrier, especially if genitals are involved (may necessitate zinc cream in patients wearing nappies).
  • if a patient is having recurrent flares of guttate psoriasis, consider whether they have recurrent Streptococcal infection in the pharynx or perianal area

Topicals

  • first line management; trial of two different agents applied liberally for at least four weeks each then as required. Options include:
    • 1) moderate (i.e. Celestone M, Tricortone, Advantan) to potent (Elocon, Eleuphrat) steroid daily (avoid areas of occlusion). Consider Clobex shampoo for scalp.
    • 2) potent topical corticosteroids +/- calcipotriol (Enstilar Foam or Daivobet ointment) in children > 6 years of age (max dose 1.5 tubes weekly in children 6-12 years of age; max dose 2.5 tubes weekly in children > 12 years of age)
  • tar based preparations; 6% salicylic acid/6% LCP in aqueous cream (avoid flexures and use in children < 6 years of age)
  • flexural areas: Pimecrolimus 1% cream or Tacrolimus 0.1% ointment daily to sensitive areas (flexures/face/genitals)
  • natural UV exposure on a daily basis e.g. 15mins, before 10am and after 4pm in summer

Clinical resources

Consumer resources

Reason for request

  • to establish a diagnosis
  • for treatment or intervention
  • for advice and management
  • for specialist to take over management
  • for a specified test/investigation the General Practitioner cannot order
  • for other reason (e.g. rapidly accelerating disease progression)
  • transfer of care from another tertiary service
  • clinical judgement indicates a referral for specialist review is necessary.

Patient demographic details

  • full name, including aliases
  • date of birth
  • residential and postal address
  • telephone contact number/s – home, mobile and alternative
  • Medicare number, where eligible
  • name of the parent or caregiver, if appropriate
  • preferred language and interpreter requirements
  • identifies as Aboriginal and/or Torres Strait Islander

Clinical modifiers

  • impact on employment
  • impact on education
  • impact on home
  • impact on activities of daily living
  • impact on ability to care for others
  • impact on personal frailty or safety
  • identifies as Aboriginal and/or Torres Strait Islander

Other relevant information

  • Willingness to have surgery, where surgery is a likely intervention.
  • Choice to be treated as a public or private patient.
  • Compensable status, e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.
  • Relevant social history, including identifying if you feel your patient is from a vulnerable population, under guardianship/out-of-home care arrangements and/or requires a third party to receive correspondence on their behalf.
  • Triage of a specialist outpatient referral is based on clinical decision making to allocate an appropriate urgency categorisation.
  • Where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service. Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
  • A change in patient circumstance (such as condition deteriorating or pregnancy) may affect the urgency categorisation and should be communicated as soon as possible.
  • All new referrals will be triaged by a consultant and appointment times scheduled according to clinical urgency.

Adolescents transitioning from paediatric to adult specialist services require a formal handover from paediatric specialist clinician to adult specialist clinician as well as a formal referral from the referring specialist to ensure initial transfer of care is completed.

The General Practitioners role in this process is to provide support to patients as part of holistic care. All ongoing referrals to specialists can subsequently be provided by the General Practitioner once the transfer of care has occurred.