This randomized controlled trial aims to compare the efficacy of Methotrexate versus Apremilast in reducing pruritus and improving quality of life in patients with psoriasis. Eighty patients aged 20 to 60 years with psoriasis involving more than 8% body surface area and associated pruritus will be enrolled and randomly assigned into two groups. Group A will receive oral Apremilast titrated to 30 mg twice daily, while Group B will receive oral Methotrexate 10 mg once weekly for 8 weeks. The primary outcome will be change in Dermatology Life Quality Index (DLQI) score at 8 weeks. Secondary outcomes include change in numerical rating scale for pruritus and assessment of adverse effects. The study will be conducted at Pakistan Emirates Military Hospital Rawalpindi.

Inclusion Criteria:

• Male and female patients aged 18 to 65 years.
• Clinically diagnosed cases of psoriasis.
• Patients experiencing pruritus associated with psoriasis.
• Patients willing to participate and provide written informed consent.
• Patients able to comply with study protocol and follow-up visits.

Exclusion Criteria:

• - Pregnant or lactating women.
• Patients with severe hepatic or renal impairment.
• Patients with known hypersensitivity to Methotrexate or Apremilast.
• Patients currently receiving systemic therapy for psoriasis within the last 4 weeks.
• Patients with active infections, including tuberculosis.
• Patients with malignancy.
• Patients with significant hematological abnormalities.
• Patients unwilling to provide informed consent.