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60% of patients with psoriasis need 2ndary care at some stage

''NICE pointers'' (vague due to chronicity and psychological implications of psoriasis)
    diagnostic uncertainty
    severe or extensive - >10% body surface area affect
    cannot be controlled with topical therapy
    major impact on a person's physical, psychological or social wellbeing - functional or cosmetic impact
    nail disease
    children / young people at presentation
    needs phototherapy (acute guttate)

same day referral - erythoderma or generalised pustular psoriasis