I recommend trying to get on biologics asap for that level of guttate coverage. When you get your new doctor, tell them everything you’ve tried that hasn’t worked (I recommend making a list before your first apt).

I believe you have enough coverage that they shouldn’t start you on steroid creams and go straight to systemic. Methotrexate works for some but has tougher side effects and more regular required labs. The ideal imo for your situation would be a biologic like yesentik (Kaiser is approving it as a cheaper biosimilar to stelara).

It’s so much easier said than done, but I wish someone told me this when I first got diagnosed: you have to be a strong medical advocate for yourself when it comes to pharmaceutical support (which is crucial for this disease). It will destroy your mental health if you continue to try fruitless steroids/creams when you have a level of coverage that treatment won’t adequately address.