Guttate Psoriasis — SCE Dermatology MCQ

Correct answer: D — Topical emollients and moderate potency corticosteroids with review

The correct answer is D, topical emollients and moderate potency corticosteroids with review. Guttate psoriasis presenting 2 weeks after streptococcal pharyngitis in an adult follows the classic pattern of small, drop-like plaques and is usually self-limiting over weeks to months, so first-line management is topical therapy rather than systemic treatment. NICE guidance on psoriasis recommends topical corticosteroids and emollients as initial treatment for guttate and plaque psoriasis, reserving escalation for cases that fail to clear. <cite index="1-3">Narrowband ultraviolet B (UVB) phototherapy is offered to people with plaque or guttate-pattern psoriasis that cannot be controlled with topical treatments alone</cite>, confirming that topical measures are the appropriate starting point before considering phototherapy or systemic agents. Why the other options are wrong: B. Long-term Acitretin: a systemic retinoid is inappropriate as first-line treatment for a self-limiting eruption and carries teratogenic and hepatic/lipid toxicity risks not justified at this stage. A. Methotrexate immediately: a systemic immunosuppressant is reserved for extensive, treatment-resistant or chronic plaque psoriasis, not an acute, likely self-resolving guttate flare. E. Anti-TNF biologic therapy: biologics are indicated for severe, treatment-refractory psoriasis failing conventional systemic therapy and phototherapy, far beyond what a first guttate presentation warrants. C. Prophylactic Penicillin V: eradicating streptococcal carriage or giving prophylactic antibiotics has not been shown to reliably prevent guttate psoriasis relapse and is not part of standard initial management. Key point: Guttate psoriasis is managed initially with topical emollients and corticosteroids with review, reserving phototherapy or systemic therapy for cases that fail to clear.

Reference: NICE, Psoriasis: assessment and management (CG153, updated), topical treatment and NB-UVB phototherapy recommendations for guttate psoriasis; https://www.ncbi.nlm.nih.gov/books/NBK553610/