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Plaque psoriasis — RACGP Fellowship MCQ

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ModerateDermatologyPlaque psoriasisRACGP Fellowship

A 48-year-old man has plaque psoriasis affecting his elbows, knees and scalp, covering about 4% of his body surface area. He has no arthritis and has previously managed it with emollients only. What is the most appropriate next step in management?

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Correct answer: E — Initiate topical corticosteroid combined with a vitamin D analogue and review response

Mild plaque psoriasis (4% BSA, no systemic features) should be managed with topical therapy, not systemic agents. Combination topical corticosteroid and vitamin D analogue improves efficacy and reduces adverse effects, consistent with Australian and international recommendations. Methotrexate is reserved for moderate‑to‑severe disease or when topical treatments fail. Oral prednisolone is contraindicated due to risk of rebound pustular psoriasis. Topical antibiotics are irrelevant, and doing nothing is inadequate.

Reference: PBS severity definitions and psoriasis treatment thresholds; PubMed: Diagnosis and management of psoriasis, 2017.