Psoriasis — SCE Dermatology MCQ

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ModerateInflammatory DermatosesPsoriasisSCE Dermatology

A 44-year-old woman presents with worsening psoriasis despite adequate Methotrexate for 3 months. Her PASI score remains 12 (moderate). She has a BMI of 24 and no comorbidities. TPMT is normal. What is the most appropriate next systemic therapy before considering biologics?

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Correct answer: D — Ciclosporin

When Methotrexate fails in psoriasis, BAD guidelines recommend trying an alternative conventional systemic agent before biologic therapy. Ciclosporin is recommended as a second-line conventional systemic option, particularly useful for rapid disease control. It is typically used as short-term intermittent therapy (maximum 1-2 years continuous). Acitretin is an option but is less effective as monotherapy for plaque psoriasis. Oral prednisolone can cause rebound flares. Hydroxychloroquine is not used for psoriasis and may exacerbate it.

Reference: BAD 2020 Guidelines for biologic therapy for psoriasis; NICE CG153