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Early Biologic Intervention — SCE Dermatology MCQ

Instant feedback + full explanation. One question, done properly.

HardInflammatory DermatosesEarly Biologic InterventionSCE Dermatology

A woman with severe palmoplantar pustulosis needs rapid systemic control because walking is impaired. Topical therapy has failed, phototherapy is unavailable and she is considering conception. Which conventional systemic drug best fits NICE guidance?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Use ciclosporin with renal and blood-pressure monitoring during the treatment course

Explanation lettering: C = shown as A · A = shown as B · D = shown as C · B = shown as D

B is correct. NICE places ciclosporin as first-choice conventional systemic therapy when rapid or short-term control is needed, for palmoplantar pustulosis, or when conception is being considered and systemic treatment cannot be avoided. It still requires renal, blood-pressure and interaction monitoring. Methotrexate is teratogenic, acitretin requires prolonged pregnancy prevention after treatment, and neither dimethyl fumarate nor hydroxycarbamide is the NICE preferred choice in this scenario. The question tests the exception to usual first-choice methotrexate.

Reference: NICE CG153 psoriasis recommendations: https://www.nice.org.uk/guidance/cg153/chapter/Recommendations