Which statement best describes the initial therapy for plaque psoriasis?

• A. Topical corticosteroids only
• B. Vitamin D analogs
• C. Systemic retinoids
• D. Topical corticosteroids; consider phototherapy or systemic therapy for extensive disease

Answer: (D)

In plaque psoriasis, start with topical therapies because they address the skin inflammation and rapid keratinocyte turnover effectively with localized treatment. Potent topical corticosteroids reduce inflammation and slow skin cell proliferation, often producing quick improvement with the least systemic risk when used short-term and with proper dosing to limit side effects like skin atrophy. If the disease is extensive, topical treatment alone is usually not enough, so you would escalate to phototherapy (such as UVB) or to systemic therapies, chosen based on disease severity and patient factors. Vitamin D analogs can be helpful, but they’re typically not used as monotherapy for extensive disease, and systemic retinoids are reserved for more severe cases due to broader toxicity.