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Plaque Psoriasis — RACP Adult Medicine MCQ

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EasyDermatologyPlaque PsoriasisRACP Adult Medicine

A 28-year-old woman presents with a new erythematous, scaly plaque on her right shin that has been present for 3 months. Biopsy shows psoriasiform hyperplasia with Munro microabscesses and dilated capillaries in dermal papillae. She is otherwise well. What is the first-line topical treatment for limited plaque psoriasis?

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Correct answer: A — Topical corticosteroid (potent, e.g. betamethasone dipropionate)

For limited plaque psoriasis (<5% BSA), potent topical corticosteroids are first-line treatment. Betamethasone dipropionate (0.05%) or mometasone furoate are commonly used. Vitamin D analogues (calcipotriol) may be used alone or in combination with corticosteroids. Combination products (calcipotriol/betamethasone – Daivobet) are convenient and effective. Topical corticosteroids should be used intermittently (e.g. weekends only) for maintenance to minimise atrophy. Emollients are adjunctive, not standalone treatment.

Reference: eTG – 2025 – Dermatology; AAD – 2024 – Psoriasis Guidelines