Appropriate initial treatment for plaque psoriasis would be:

Plaque psoriasis is a chronic inflammatory skin disorder characterized by well-demarcated erythematous plaques with silvery scaling, resulting from rapid keratinocyte turnover and immune-mediated inflammation. Initial treatment is typically based on disease severity, with mild to moderate cases managed using topical therapies that reduce inflammation and control plaque formation. Corticosteroids are the mainstay of first-line therapy due to their strong anti-inflammatory effects and rapid symptom control when used appropriately. Rationale: A. Anthralin (Dritho-Creme) is effective for psoriasis by slowing keratinocyte proliferation, but it is not commonly used as initial therapy due to its irritant properties, staining of skin and clothing, and need for careful application. It is generally reserved for more resistant plaques or as an adjunct therapy rather than first-line treatment. B. Pimecrolimus (Elidel) is primarily indicated for atopic dermatitis, especially in sensitive areas such as the face or intertriginous regions. It is not considered a first-line treatment for plaque psoriasis because it has limited efficacy on thick, scaly plaques found in typical psoriatic lesions. C. Burow’s solution (aluminum acetate) wet soaks are used for soothing inflamed or weeping skin conditions, such as acute dermatitis or minor skin infections. While they may provide symptomatic relief, they do not address the underlying immune-mediated inflammation of plaque psoriasis and are not effective as primary treatment. D. Triamcinolone 0.1% (Kenalog) is an appropriate initial treatment for plaque psoriasis because it effectively reduces inflammation, erythema, and scaling. Intermittent “pulse” therapy helps minimize side effects such as skin atrophy while maintaining disease control. Topical corticosteroids are considered first-line therapy for localized mild to moderate plaque psoriasis due to their efficacy and rapid symptom relief.