When should I consider referring a child with suspected psoriasis to a dermatologist?

Consider referring a child with suspected psoriasis to a dermatologist if:

• The diagnosis is uncertain or unclear after initial assessment.
• The psoriasis is severe, extensive, or not responding to appropriate topical treatments such as potent corticosteroids or vitamin D analogues.
• There is difficulty in managing the condition with first-line topical therapies, or if specialist treatments like very potent corticosteroids or dithranol are being considered.
• The child requires specialist advice on the safe and effective use of topical treatments, especially given the variable licensing and age restrictions for potent corticosteroids and vitamin D analogues in children.

Referral is particularly important to ensure appropriate assessment, monitoring for adverse effects, and tailored management in a specialist setting.

This approach aligns with NICE guidance on psoriasis management in children and young people, which emphasises specialist involvement when treatment response is inadequate or when potent therapies are needed under supervision ².