VIDEO: Positioning topical, systemic treatments in psoriasis

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It depends on how much psoriasis someone has, where they have their psoriasis, how much the psoriasis is bothering the patient, how well the treatments are working, right? So like, you know, anyone who has a few patches or plaques of psoriasis, you know, can start with a topical treatment to see how well that works. They can try that for two or three months. And you know, a patient might notice that a topical treatment is good enough for them. You know, it's enough to kind of keep their psoriasis under control with intermittent therapy.

And a lot of patients don't need to move beyond topical treatments. But when the topical treatments are not working and patients find that it's either too much or it's just not controlling their psoriasis well enough, or if it's in a location where it's just difficult to use, then the next step would be to go to one of the systemic treatment options that work inside the body. Whether it's some of the oral options or one of the many really good injectable biologic options we have. There's also phototherapy, which is obviously an option for these patients too.

If it's in some of these difficult to treat areas, some patients may need a biologic. And I know if someone has severe scalp involvement where it's thick plaques covering scalp and if it's covering most of the scalp, I know that they're probably not gonna do well with a topical. We might give that to them just to start and to show the insurance company that they failed. But we know that these patients probably will need systemic option to do well. Same thing goes with patients with the add involvement sort of in the hands and feet. You know, those are typical areas that don't always do a great job treating with just creams and lotions. And then the other consideration obviously is someone who's got evidence of psoriatic arthritis, right?

If the pain, discomfort, stiffness from their psoriatic arthritis is such that it's sort of interfering with their quality of life and if it's something that's deemed to be moderate to severe, that's gonna often be a patient who's gonna need probably systemic treatment, even if they have only a little bit of psoriasis on their skin. So that comes into play too as well in someone who might have both skin and joint disease.