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Psoriasis — SCE Dermatology MCQ

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EasyInflammatory DermatosesPsoriasisSCE Dermatology

A 42-year-old man has inverse (flexural) psoriasis affecting his axillae and groin. The plaques are smooth, shiny, and erythematous without the typical silvery scale. What is the most appropriate topical treatment?

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Correct answer: A — Mild-to-moderate topical corticosteroid or topical calcineurin inhibitor

Flexural (inverse) psoriasis lacks the typical thick silvery scale due to the moist environment. Treatment differs from plaque psoriasis: mild-to-moderate potency topical corticosteroids (not potent/ultrapotent, as flexural skin is thinner and more susceptible to steroid atrophy) or topical calcineurin inhibitors (Tacrolimus/Pimecrolimus — steroid-sparing and no atrophy risk) are recommended. Coal tar and dithranol are irritant in flexures and should be avoided. Combined Calcipotriol/Betamethasone gel is not recommended for flexural use. Short-contact therapy can be considered if needed.

Reference: BAD 2020 Psoriasis Guidelines; NICE CG153