skip to main content

Psoriasis — SCE Dermatology MCQ

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

ModerateDermatopharmacologyPsoriasisSCE Dermatology

A 45-year-old man with widespread psoriasis (PASI 18, DLQI 15) has failed adequate trials of Methotrexate and Ciclosporin. He has no contraindications to biologics. According to NICE, what is the recommended approach to selecting a first biologic?

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

Reveal the answer and explanation

Correct answer: C — Choice should consider individual patient factors, comorbidities, drug characteristics, and cost-effectiveness — shared decision-making is required

NICE biologic commissioning policies and BAD guidelines recommend that first biologic choice for psoriasis should be based on individual patient factors (comorbidities, lifestyle, fertility plans, needle phobia), drug characteristics (mechanism, dosing schedule, route, onset of action, evidence for specific manifestations like nail/joint disease), safety profile, and cost-effectiveness. Shared decision-making between the dermatologist and patient is emphasised. For example: IL-17 inhibitor if predominant nail or joint disease; anti-TNF if concurrent IBD; IL-23 inhibitor for patients wanting infrequent dosing; avoiding IL-17 inhibitors if IBD present. Biosimilars should be considered where available for cost-effectiveness.

Reference: BAD 2020 Biologic Psoriasis Guidelines; NICE CG153