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What do you do for patients on dupilumab who develop a psoriasis phenotype and biopsy indicative of psoriasis?

Atopic Dermatitis

You. So this is fascinating, because I think this is actually fairly rare. Sometimes you'll hear people talk about the th one and th two system being like a teeter totter. I don't think that's really true. I think that's an oversimplification, because I think if that were true, we would just have legions of patients treated for psoriasis with terrible eczema, and legions of eczema patients treated for eczema. Now, with psoriasis, we would see these flipping. In fact, it's quite rare, but there's no doubt. I think some patients have an overlap, and so that when you treat one of those, you actually do get the teeter totter. I mean, there's some truth to this, and then you see that the psoriasis is worsening. So. Absolutely. What do I do in those situations? Well, it's interesting. Sometimes we've been able to just do good control with topicals. Sometimes, again, we've added phototherapy, which kind of kills two birds with 1 st or feeds two birds with one scone. More pet friendly way to do it. That's great. Sometimes we've switched and we've gone to something that might have anti inflammatory treatments for both, from conventional immunosuppressants like cyclosporin, to a jack inhibitor. These things can really help, but I really try to do it on a patient by patient basis, because sometimes, I would argue the majority, I'm able to do it with topical psoriasis care and get them in good enough shape. And usually their eczema was so bad that they don't want to mess around with changing unless their psoriasis becomes seriously bad as well. Thank.

What do you do for patients on dupilumab who develop a psoriasis phenotype and biopsy indicative of psoriasis?

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