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Phototherapy — SCE Dermatology MCQ

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HardPhotobiologyPhototherapySCE Dermatology

Plaque psoriasis uncontrolled by topical treatment clears with narrowband UVB but returns to more than half its pretreatment severity eight weeks later. What is the most appropriate NICE-consistent phototherapy plan?

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

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Correct answer: A — Move to another second- or third-line treatment after this rapid relapse

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

D is correct. NICE defines rapid relapse after phototherapy as return of more than 50% of baseline severity within three months. In that situation, another second- or third-line treatment should be considered rather than maintenance phototherapy. A further finite narrowband-UVB course can be considered after a later relapse, but it does not address this rapid-relapse decision. PUVA requires an individual risk–benefit review rather than being the default escalation. Scheduled maintenance phototherapy is not routinely recommended, and transferring the same clearance regimen to a home unit does not change the significance of rapid relapse.

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