PIP for Eczema and Psoriasis - Can You Claim?

Severe eczema and psoriasis go far beyond "dry skin." Cracked, bleeding skin that makes washing agonising. Hands too raw to grip anything. Clothing sticking to weeping wounds. Hours spent applying creams and bandages daily. Sleep destroyed by itching. Yet many people don't claim PIP because they think skin conditions aren't "serious enough." If your skin condition significantly affects your daily life, it is.

Which PIP Activities Are Affected?

Washing and Bathing (Activity 4) - This is often the highest-scoring activity. Water on cracked, broken skin is extremely painful. Soap and shampoo cause stinging. Drying off by rubbing with a towel tears skin. Many people with severe eczema or psoriasis need someone to help apply emollients to unreachable areas, or need to wash in stages because the pain is too intense to do it all at once.

Dressing and Undressing (Activity 6) - Clothing rubbing against affected skin causes pain and bleeding. Bandages and wet wraps need applying before dressing. Buttons and zips are difficult with cracked, painful hands. Choosing clothing that won't irritate skin takes extra time and consideration.

Managing Therapy (Activity 3) - Be careful here, because this activity is not scored by adding up your skin care time. Emollients, steroid creams, bath oils and biologic injections are all medication, so needing an aid, prompting or help with them is descriptor 3b, 1 point, however long it takes. Blood tests for immunosuppressants are monitoring, which also falls under 3b. The higher descriptors (2 to 8 points) are only for prescribed therapy done at home that another person has to supervise, prompt or assist with, for example a partner putting on prescribed wet wraps or bandages, and only the time they spend helping counts. Phototherapy at hospital and dermatology appointments do not count as therapy. Many people with severe eczema spend 1-2 hours per day on skin management alone, so describe that burden, but claim it under the right descriptor.

Preparing Food (Activity 1) - Cracked hands make gripping knives, peeling vegetables and handling hot items painful and dangerous. Contact with food (especially acidic foods like tomatoes, citrus) burns broken skin. Washing up is agonising.

Engaging with People (Activity 9) - Visible skin conditions cause profound embarrassment and social withdrawal. Depression and anxiety from the appearance and constant discomfort. Many people avoid social situations entirely during flares.

Sleep - While sleep isn't a PIP activity, severe itching that keeps you awake affects EVERY activity the next day through exhaustion. Mention sleep disruption under each activity: "Due to severe itching keeping me awake until 3am, I am too exhausted to [cook/wash/dress/go out] on most days."

Psoriatic Arthritis

If your psoriasis has led to psoriatic arthritis, claim for both conditions. Psoriatic arthritis affects mobility (Activity 12), dressing (Activity 6), food preparation (Activity 1) and managing therapy (Activity 3). The combined scoring is significantly higher than either condition alone.

What Evidence Helps?

• Dermatologist letters with severity scoring (EASI, PASI or DLQI scores)
• Photos of skin during flares (dated)
• Prescription records showing quantity of emollients and treatments
• Phototherapy records
• Mental health professional letters about psychological impact
• Partner or carer statement describing daily skin care routine

Severity Scoring Systems and PIP

Three dermatology scoring tools are accepted as objective evidence:

• EASI (Eczema Area and Severity Index): Scores 0-72. Above 21 = severe; above 50 = very severe. NHS criteria for biologic eligibility.
• PASI (Psoriasis Area and Severity Index): Scores 0-72. Above 10 = severe. NHS biologic criteria require PASI 10+ with DLQI 10+.
• DLQI (Dermatology Life Quality Index): 0-30. 11-20 = very large effect; 21-30 = extremely large effect.

Request these scores from your dermatology team. Numbers above the severe threshold are powerful PIP evidence.

Activity 3 Detailed Calculation for Severe Skin Conditions

Since 2017 Activity 3 has been split into medication, monitoring and therapy, and only therapy can score more than 1 point. Where the usual skin care routine falls:

• Daily emollient application: applying medication topically, so descriptor 3b (1 point) if you need an aid, prompting or another person to do it, no matter how long it takes
• Topical steroid application: medication, so also 3b (1 point) at most
• Bandaging or wet wrapping: prescribed dressings put on by a partner or carer can count as therapy. Only their hands-on time counts: 30 min daily = 3.5 hours/week (3c, 2 points); 60 min daily = 7 hours/week (3d, 4 points)
• Bath/shower with bath oils, special soaps: not therapy. Describe the extra time and pain under Activity 4 (washing and bathing)
• Phototherapy sessions: given at hospital, so not therapy "undertaken at home". Describe the fatigue and travel burden elsewhere on the form
• Biologic injections or infusions: medication, so 3b (1 point) if you need help or an aid to self-inject
• Dermatology appointments: not therapy. Useful as evidence of severity, not as hours
• Blood monitoring (for systemic medication): monitoring a health condition, so 3b (1 point) if you need help with it

The therapy descriptors are 3c (no more than 3.5 hours a week, 2 points), 3d (more than 3.5 up to 7 hours, 4 points), 3e (more than 7 up to 14 hours, 6 points) and 3f (more than 14 hours, 8 points). The hours are the time another person spends supervising, prompting or assisting with prescribed home therapy, not the time the treatment is on your skin. For most people with a skin condition the bigger scores come from Activities 1, 4, 6 and 9.

Severe Forms That Qualify Most Clearly

• Erythrodermic psoriasis: 90%+ body coverage, life-threatening. Hospital admission. Almost always qualifies for enhanced rates.
• Pustular psoriasis (von Zumbusch): Acute severe form with pustules, fever. Often requires hospitalisation.
• Generalised severe atopic eczema: Adult severe eczema. NHS biologic eligibility evidence.
• Discoid eczema with infection: Recurrent infected lesions.
• Severe hidradenitis suppurativa: See dedicated guide. Often very severe functional impact.
• Severe contact dermatitis (occupational): May force career change.
• Bullous skin diseases (pemphigus, pemphigoid): Severe blistering. Often qualifies for enhanced rates.
• Epidermolysis bullosa: Genetic blistering condition. Severe and lifelong.

Systemic Treatment Side Effects

Severe eczema/psoriasis often requires systemic immunosuppression:

• Methotrexate: Fatigue, nausea, hair thinning, liver monitoring
• Ciclosporin: Hypertension, kidney monitoring, infection risk
• Azathioprine: Liver, blood count monitoring
• Acitretin (psoriasis): Dry mucous membranes, blood lipid changes, teratogenic
• Biologics (adalimumab, secukinumab, ustekinumab, ixekizumab, risankizumab, brodalumab, dupilumab, tralokinumab): Self-injection, infection risk, requires NHS criteria met
• JAK inhibitors (upadacitinib, abrocitinib, baricitinib): Newer oral medications. Cardiovascular monitoring required.

Document side effects affecting daily activities. Many systemic medication patients qualify based on combined skin and side effect impact.

The Mental Health Dimension

Severe skin conditions cause profound psychological impact:

• Body dysmorphia: Visible disfigurement causes significant distress
• Depression: A large proportion of people with severe psoriasis or eczema have clinical depression
• Anxiety: Fear of flares, social embarrassment
• Suicidal ideation: Significantly raised in severe skin conditions
• Sleep disturbance: Itching, pain, sleep medication

List mental health as a separate condition on the form. The combined impact qualifies for higher PIP rates.

Frequently Asked Questions

Is my eczema/psoriasis severe enough for PIP?

If you spend 1+ hours daily on skin care, have multiple functional difficulties (washing, dressing, work limitations) and your DLQI is above 10, you likely qualify. Mild conditions managed with simple emollient typically do not qualify alone.

I am on biologics for severe psoriasis - what does this mean for PIP?

Biologic eligibility (PASI 10+ and DLQI 10+ on UK criteria) demonstrates severity. The biologics often work well, but ongoing treatment burden, residual symptoms and side effects mean most patients continue to qualify for PIP.

My eczema is well-controlled now - can I still claim?

Atopic eczema often fluctuates with flares. PIP looks at majority of days. If your function is significantly affected on more than half of days, you qualify. Even controlled eczema requires daily maintenance and is at risk of flaring.

I have severe eczema affecting my hands only - does that count?

Hand eczema is particularly disabling because it affects Activities 1, 4, 6 directly. Cooking, washing, dressing and any task requiring grip is affected. Many hand eczema patients qualify for standard daily living.

Does scalp psoriasis count?

Yes if it significantly affects daily life. Severe scalp psoriasis causes hair loss, embarrassment, sleep disturbance from itching and difficulty washing hair. The mental health impact often qualifies it for PIP alongside other factors.

What about pompholyx (dyshidrotic eczema)?

Pompholyx causes intensely itchy blisters on hands and feet. Affects Activities 1, 4, 6, 12. Often recurrent and resistant to treatment. PIP-eligible if functional impact is significant.

I have eczema herpeticum - is this a one-off?

Eczema herpeticum is a serious complication of eczema (HSV infection in eczematous skin). It is an emergency but episodes can recur in severe eczema. Document past episodes as evidence of severity.