skip to main content

Sunscreen — SCE Dermatology MCQ

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

HardPhotobiologySunscreenSCE Dermatology

After three months at methotrexate 20 mg weekly, a patient’s PASI has fallen from 18 to 9 and DLQI from 17 to 13. Adherence and dose are satisfactory. How should this response be classified under NICE CG153?

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

Reveal the answer and explanation

Correct answer: D — Stop methotrexate because PASI 50 lacks the required DLQI 5 response

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

B is correct. NICE assesses methotrexate after three months at the target dose. Adequate response is PASI 75, or PASI 50 together with a five-point improvement in DLQI. This patient has PASI 50 but DLQI has improved by only four points, so the combined threshold is not met and another treatment should be selected. PASI 50 alone is insufficient, while increasing methotrexate above the recommended maximum of 25 mg weekly is not the remedy for a defined inadequate response. Adherence, toxicity and patient preference still inform the next choice.

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