Hello. Thanks for writing to us at healthcaremagic Dermatologists have long experience of using Methotrexate in psoriasis. It is very effective and takes good control of psoriasis even with the most severe of presentations like pustular psoriasis as well as erythrodermic psoriasis. It is one of the treatments of choice for plaque psoriasis as well, involving large areas of the body. One of the reasons for it not being very effective this time round could be because either its dosage is insufficient for the severity of psoriasis Or it is not being absorbed properly from the gut. Along with Methotrexate, topical treatment forms an important part of the ovarall treatment of psoriasis and adds to the response. Topical treatment with topical steroids+salicylic acid combination Or topical Vitamin D analogues like calcitriol and calcipotriol can be started along with oral methotrexate. I would suggest that you seek another appointment with your dermatologist who would assess the severity of psoriasis and either increase the dose Or may change the route of administration to injectable (Injectable Methotrexate i/m Or i/v can be tried) and may add topical treatment. Your dermatologist after thorough assessment of the skin condition would be able to guide you properly. Regards