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Dermbits

How do you approach management of plaque psoriasis in challenging sensitive areas?

Psoriasis

You. So it's true that some of these more delicate areas, like the intertrignous areas and the genital skin and facial skin, these can be tricky. And these are areas that I really like to minimize topical corticosteroid exposure. It doesn't mean I don't use them. I do. But it's one of those places where I think you can see people get in a very vicious cycle where they're needing to use an awful lot of steroids, sometimes increasing their dose for a long time in a way that I don't think is safe. And I've, over the years, inherited patients that have quite impressive stria that is now, of course, permanent or skin thinning and atrophy, where you say, boy, you really need to stop using it. Here we've seen people get folliculitis from it. We've seen fungal infections that have been inappropriately treated with steroids. So I think we have to keep an eye on that. And for some patients, it's going to be enough. But for many patients, I really like to incorporate non steroidal agents in whenever we can. And again, it doesn't mean we have to replace them completely, the steroids, but ideally we're going to minimize their use only for if the non steroidal can't manage it. But with something like topica reflumlast, I've found that actually it can. It can do a great job, especially in these more sensitive skin areas as a monotherapy. And I think that's a win win. I also like the fact that for many of my patients, they tell me I don't have to use it all the time. I can use it for a bit. When I'm better, I take a break, like. So again, they're intermittently using even this more safe category, which I really love. My goal is to be using as little medicine as possible to get people to where I want them to be, which is ideally clear or almost clear all the time, or most of the time, and feeling really good about their treatment, therapy and.