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What are the advantages of topical therapy as monotherapy over systemic therapy for plaque psoriasis?   

Psoriasis

You. The topical therapy as monotherapy, of course, has advantages. If a patient has mild psoriasis, they would be not a candidate for systemic therapy, because the guidelines for systemic therapy are pretty clear that patients need to have moderate to severe plaque psoriasis, and that's sort of stratified, based on body surface area, with five to 10% moderate psoriasis and upwards of 10% being severe. So if I have a patient in my practice that has anything from one to five ish percent, they are sort of an ideal candidate for topical therapy. And I certainly use reflumilast as monotherapy in that case. The other advantages of topical therapy is that sometimes if a patient is on a systemic agent and they have a risk ultra plaque, or if they have a psoriasis lesion in an area which is maybe sensitive, like an intertiginous site, roflomlast has great data on intragenous ig improvement. So I sort of add that on in my practice, and sometimes we have patients who don't want to do a systemic therapy, or there's a contraindication to a systemic therapy, like maybe they have an active malignancy, or they can't do phototherapy because of the commitment that it entails of finding a phototherapy site. So topical therapies definitely have an advantage because it's ease of use. Patients can do it in the comfort of their house, they don't have to travel anywhere for it. And with topical reflummalas, there's no monitoring that's needed. So that's another advantage, which obviously systemic therapy doesn't afford, because there's definitely some blood of work that happens when it comes to systemic therapy, whether it's baseline or ever. So often as a follow up.