Overcoming Delays in Systemic Treatment Escalation for PsO

In ‘Overcoming Delays in Systemic Treatment Escalation for PsO,’ our panel explores why some patients with plaque psoriasis remain on topical therapy despite persistent disease burden and potential candidacy for systemic treatment. The discussion begins with data showing that patients with relatively low body surface area may still perceive their psoriasis as moderate and that many continue to cycle through multiple topical therapies without escalating treatment.

The faculty identify several reasons for delayed escalation, including clinician comfort with systemic therapy, longstanding reliance on topical treatment in dermatology, and concerns about safety with newer medications. Dr. Stein Gold describes how conversations can change when psoriasis is framed not simply as a skin condition but as a systemic inflammatory disease, particularly when patients have substantial disease burden or possible psoriatic arthritis.

The panel also stresses the importance of clinician confidence and education. As systemic therapies have become more targeted and extensively studied, the faculty argue that providers should understand both their benefits and risks well enough to discuss them clearly with patients. Modern psoriasis care increasingly requires determining when topical treatment is no longer sufficient and when a systemic approach is more appropriate.

Our next episode, ‘Choosing Between Oral and Injectable PsO Therapy,’ examines how route of administration influences treatment decisions and how newer oral therapies may provide additional choices for patients considering systemic treatment.