In plaque psoriasis, which is considered first-line for mild to moderate disease?

• A. Methotrexate
• B. High-dose topical steroids
• C. PUVA
• D. Biologic agents

Answer: (B)

For mild to moderate plaque psoriasis, starting with topical therapy to control skin lesions is the most appropriate approach. The most effective topical option is a high-potency corticosteroid because it directly suppresses the inflammatory processes driving plaque formation and slows the rapid skin-cell turnover that creates thick, scaly plaques. This leads to quicker flattening of plaques, less redness, and reduced scaling.

Because of potential side effects like skin thinning and systemic absorption, these potent steroids are used for the shortest possible duration and tailored to the area treated. Often they’re paired with a vitamin D analog to boost efficacy and allow for steroid-sparing. For more extensive disease, or if topical therapy isn’t enough, phototherapy or systemic treatments such as methotrexate or biologics are considered.