<s>[INST] Hi, I m 22 and have moderate to severe plaque psoriasis on my face, scalp and torso. I ve exhausted most topical creams and ointments, taken courses of steroids with no real results. Would phototherapy be my next course of action. Is thinking about biologics too radical? [/INST] Hello. Thank you for writing to usTopical treatment with ointments and lotions is usually combined with systemic treatment/ oral treatment for psoriasis involving > 20% body surface area.Phototherapy, though is a good choice for extensive body involvement with plaque psoriasis, however, certain body sites like scalp are resistant even to phototherapy.Apart from phototherapy Oral methotrexate is a well known treatment for plaque psoriasis and can be considered in a healthy young adult.Biologics like adalimumab, ustekinumab are not first line options in a young patient with limited involvement with plaque psoriasis.Scalp involvement responds well to topical steroids lotions with or without salicylic acid.Vitamin D anlogues e.g calcipotriol/ calcitriol lotions are also effective in scalp psoriasis.I suggest that you visit a dermatologist in your region.Your dermatologist will assess the severity of involvement and advice accordingly.Regards </s>