Hello. Thank you for writing to us at healthcaremagic Psoriasis is a chronic skin condition. The patches in psoriasis are red, scaly and distributed at various body sites, predominantly extensor skin surfaces like elbows, knee and scalp. The disease has a remitting and relapsing course i.e it may re-occur after a seemingly complete cure. Methotrexate is very effective in treating psoriatic patches. Though it is a common drug for treating psoriasis but caution should be exercised in terms of the total cummulative dose; it should be a guide to certain investigations. A liver biopsy is recommended after reaching a total cummulative dose of 1.5 grams of methotrexate, to look for any early/developing fibrotic changes in Liver. In an effort to reduce the total cummulative dose, Methotrexate can be either combined with other treatment modalities like Phototherapy, Acitretin, topical modalities Or it can be alternated with other Immunosuppressive like Cyclosporin. Since you have been taking Methotrexate for 3 years now, amounting to a total cummulative dose of 640 mg, therefore, my approach in you would be to use Methotrexate judiciously i.e either alternated with other Immunosuppressives like Cyclosporin Or combined with Phototherapy and topical treatment modalities. Biologics are newer entrants in the treatment of psoriasis. They specifically target the immune mechanisms involved in the pathogenesis of psoriasis. They are expensive but also produce long lasting remissions. I suggest you to discuss about these points in more details with your treating dermatologist. Regards