In this session, audience members gathered to hear therapeutic pearls for psoriasis from one of the masters of psoriasis, Mark Lebwohl, MD. Beginning with pearls on vaccinations for patients on systemic psoriasis treatments, Dr Lebwohl told the audience that no dosage adjustment is needed for non-live vaccine administration for most psoriasis drugs, with the exception of methotrexate. For live vaccines, Dr Lebwohl recommended discontinuing drug two to three half-lives before vaccine administration and deferring the next dose for 2 to 4 weeks. Dr Lebwohl’s next tip centered on perioperative management of patients with psoriasis on systemic treatment. For low-risk procedures, most systemic medications can be safely continued. For intermediate- and high-risk surgeries, most oral and biologic treatments are likely safe, but a case-by-case approach should be taken. Dr Lebwohl recommended withholding TNF blockers for one dose prior to surgery.

Moving on to one of the hottest topics in medicine today, Dr Lebwohl discussed the adjunctive use of glucagon-like peptide 1 (GLP-1) receptor agonists in patients with inflammatory arthritis or psoriasis. A review found that 4 of 5 clinical studies demonstrated significant improvements in PASI scores with no major adverse events. Dr Lebwohl reviewed induction dosing for tirzepatide and informed the audience that no blood monitoring is required when prescribing these medications. Common side effects include nausea, vomiting, and diarrhea. Antidiarrheals and antiemetics such as loperamide and ondansetron, respectively, can be helpful for managing side effects.

Dr Lebwohl reminded the audience that large registry studies have found patients with psoriasis have an elevated relative risk of incident Crohn disease. For patients with both psoriasis and Crohn disease, risankizumab, an IL-23 inhibitor, can be an effective treatmentand is approved in intravenous form for Crohn disease. Systemic treatments should not be withheld from patients with low body surface area psoriasis, such as scalp and nail psoriasis only. Studies have shown that patient satisfaction significantly improves when those with “mild-” or low-BSA psoriasis are given systemic therapy. To conclude, Dr Lebwohl gave tips on the short-term use of IL-17 inhibitors for guttate psoriasis and discussed the importance of rapidly treating acute generalized pustular psoriasis flares with spesolimab without waiting for skin biopsy results.