Synopsis
Select and sequence specialist psoriasis treatment beyond topicals, obtain informed consent, prevent phototherapy and medicine harm, and monitor response using skin, joint and life-impact outcomes.
- NICE offers narrowband UVB to plaque or guttate psoriasis not controlled with topical treatment alone; two or three sessions weekly are options, with faster response commonly achieved at three.
- Phototherapy is prescribed treatment, not advice to sunbathe: consent covers burns, photosensitivity, photoageing, cumulative skin-cancer risk, attendance and eye or genital protection where required.
- Do not use phototherapy routinely as maintenance; change strategy after poor tolerance, inadequate response, rapid relapse beyond half of baseline within three months, impractical access or especially high skin-cancer risk.
Key red flags
Fever, diffuse pustules, extensive tender inflammation, haemodynamic change or reduced urine output requires acute specialist assessment before routine treatment selection.
Generalised pustulation, erythroderma, fever, malaise, fluid loss or physiological deterioration bypasses routine outpatient sequencing and needs same-day specialist treatment.
Investigation priorities
Confirm treatment eligibility and provide a comparator for response across skin, high-impact sites and quality of life.
Management branches
Plaque or guttate psoriasis not controlled by topical treatment alone and no urgent instability.
- Confirm diagnosis, extent, skin cancer and photosensitivity history, medicines, previous ultraviolet exposure, ability to attend and informed consent.
- Offer supervised narrowband UVB two or three times weekly; explain that three sessions weekly may achieve response faster while total course and doses remain unit-prescribed.