In this episode of Derms and Conditions, host James Del Rosso, DO, welcomes Ron Vender, MD, Associate Clinical Professor of Dermatology at McMaster University, to discuss practical strategies for psoriasis treatment and the management of chronic hand dermatitis. 

They begin with Dr Vender sharing his 90/70/40 rule, a numeric approach to evaluating biologic efficacy in psoriasis. He explains that across biologic agents, PASI75 responses typically reach 90%, PASI90 responses reach 70%, and PASI100 responses about 40%, providing a useful benchmark for evaluating treatment success. With many biologics showing similar efficacy and strong safety profiles, this method can help guide selection. 

They also discuss how comorbidities impact biologic choices, with Dr Vender noting he avoids TNF inhibitors in patients with multiple sclerosis, latent tuberculosis, malignancy, or hepatitis, though they remain a preferred option for women of childbearing potential. He advises caution when using IL-17 inhibitors in patients with a history of inflammatory bowel disease. While tuberculosis screening remains routine, he questions its necessity for anti-IL-17 and IL-23 inhibitors, given their lack of association with latent TB reactivation. 

The discussion then moves to chronic hand dermatitis, with Dr Vender stressing thorough history-taking, including identifying occupational exposures, and diagnostic testing, including patch testing and scrapings. He highlights alitretinoin, an oral retinoid specifically approved for chronic hand dermatitis, as an effective and well-tolerated treatment option. They conclude with a discussion on protective measures for chronic hand dermatitis, including hypoallergenic gloves, cotton liners, and emollient barrier creams. 

Tune in to the full episode to hear expert insights on optimizing psoriasis treatment and managing chronic hand dermatitis in clinical practice.