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When augmenting oral and/or biologic therapy with a topical, what are some of the considerations you think through?

Psoriasis

You. I would say that 100% of my patients who are on a systemic therapy, be that an oral medicine, phototherapy, or a biologic, 100% of them are also going to be on concomitant topicals. Now, my hope is they're going to be using them much less frequently to much less body surface area than they were before. But I have almost no patients who are literally perfectly clear on their system. Agent don't need anything at any point in the year. Sometimes it's just a few weeks, or maybe they're like, boy, my elbows are getting really dry in the winter. I'm going to use something. So I do. I mix and match quite a bit. And in general, we have a pretty long leash. There are not too many specific contraindications to our topicals and systemics, although some insurance companies have pushed back. Of course, if you're using a very expensive biologic agent and a very expensive topical, that can be a real issue. So we try to be cognizant of that. And if someone doesn't need a more sophisticated topical, it may be fine to use something that's inexpensive or accessible and even over the counter treatment. I'm a huge proponent for OTCs because I think that optimizing our OTC treatment can be incredibly safe and incredibly effective as part of a regimen minimizing the need for other systemics or other topical agents that are medicated and truly prescription based.

When augmenting oral and/or biologic therapy with a topical, what are some of the considerations you think through?

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