Referral pathways & tools
Referral tools & forms
Sample patient pre‑visit form
To assist gathering relevant information from patients in order to assess potential PsO, a sample patient pre‑visit for is found here.
Sample referral form
For patients for whom referral to dermatology may be indicated, a sample referral form is found here.
When might a referral be indicated?
Use body surface area (BSA) and Physician’s Global Assessment (PGA) Severity Tools along with photographs to support documentation required for insurance approval of referral.
Uncertain diagnosis
Doubt about whether the condition is truly PsO.
Severe PsO
>10% BSA, generalized, or hard‑to‑treat locations. Consider referral for possible systemic or biologic therapy.
Treatment failure in primary care
Topicals ineffective after 4–8 weeks of appropriate use.
Psoriatic arthritis suspected
Joint pain, stiffness, or swelling—consider dermatology/rheumatology input.
Frequent flares or relapses
Ongoing poor control or reduced quality of life despite treatment.
Complex cases
Multiple comorbidities or need for coordinated, multidisciplinary care.
Psychological impact
Significant patient distress, depression, or anxiety due to PsO may benefit from psych referral.
Special populations
Pregnant individuals, children, elderly.
Severity assessment
Severity guides treatment, referral, and insurance documentation. Document severity to guide these activities. Consider use of photos to document lesions to help with insurance documentation.
Higher scores = more severe PsO
Body surface area (BSA)
Estimates affected skin area: 1 palm = ~1% BSA.
Severe PsO typically affects >10% of BSA.
Lesions in high‑impact areas (scalp, hands, feet, genitals, areas where skin folds) may cause greater functional impairment and require more intensive treatment.
Physician’s Global Assessment (PGA)
Used with BSA to guide treatment and support documentation. Higher scores may prompt referral or therapy escalation.
Rates severity on a 5‑point scale
(eg, 0 = clear, 1 = almost clear, 4 = severe).
Assesses key features:
- Thickness or induration
- Erythema
- Scaliness
Comorbidity assessment
PsO is a systemic inflammatory condition—screen for and manage associated comorbidities.
| Comorbidity | Recommendation for screening and management |
|---|---|
Psoriatic arthritis | Screen for symptoms and image, as necessary, consider rheumatology referral if present |
Cardiometabolic disease | Monitor for hypertension, diabetes, obesity, hyperlipidemia, counsel on health lifestyle, diet, weight, and exercise |
Inflammatory bowel disease | Elicit bowel symptoms, refer to gastroenterology if present |
Liver and kidney disease | Monitor complete metabolic profile, consider specialist referral if abnormalities present |
Mood disorders | Elicit symptoms, consider screening questionnaires, refer to appropriate specialist |
Ensure patients are informed of elevated risks and referred appropriately.