Light Treatment, Stelara, Fumaderm???

[Fred]

Hi, nice to meet you  

I think you will be offered methotrexate next, as per the NICE pathway. (Look up nice pathway psoriasis and click on systemic therapy which is next after light therapy).
But perhaps if you go in and ask about something specific you may go down another route. They aren't very likely to offer you Stelara until you have tried and ruled out methotrexate first. They work their way up the price of the drugs I guess!

Good luck with the derm, I'm seeing mine tomorrow too!

We have a copy of the clinical guideline on the assessment and management of psoriasis for GPs and it states:

"In this guideline, first-line therapy describes traditional topical therapies (such as corticosteroids, vitamin D and vitamin D analogues, dithranol and tar preparations). Second-line therapy includes the phototherapies (broad- or narrow-band ultraviolet B light and psoralen plus UVA light [PUVA]) and systemic non-biological agents such as ciclosporin, methotrexate and acitretin. Third-line therapy refers to systemic biological therapies such as the tumour necrosis factor antagonists adalimumab, etanercept and infliximab, and the monoclonal antibody ustekinumab that targets interleukin-12 (IL-12) and IL-23."

You can read more of it here NICE issues new guidance for GPs treating psoriasis

So yes probably Methotrexate as most go that way, but it could also mean Ciclosporin and Acitretin.