Patient Preferences and Shared Decision-Making in Psoriasis Care

In this episode, ‘Patient Preferences and Shared Decision-Making in Psoriasis Care,’ the expert dermatologists explore the nuanced process of transition from topical to systemic therapy. Dr. Mark Lebwohl explains that while a 10% body surface area (BSA) often serves as a traditional threshold, systemic treatment is frequently necessary for patients with lower BSA if the psoriasis affects high-impact areas like the palms, soles, genitals, or hairline. He emphasizes that the National Psoriasis Foundation provides crucial support for clinicians to advocate for systemic options when a patient’s quality of life is significantly impaired, regardless of objective coverage scores.

Dr. Tina Bhutani-Jacques and Dr. Lebwohl discuss how they navigate the "shared decision-making" conversation by presenting patients with the full spectrum of modern options, including ultraviolet light, oral pills, and biologics. Dr. Lebwohl notes that specific patient needs—such as the requirement for rapid clearance before a wedding or a job interview—often push the choice toward faster-acting biologics. Conversely, comorbidities play a decisive role; for instance, IL-17 blockers are preferred for patients with multiple sclerosis, while they are avoided in those with Crohn's disease. The experts also touch on the "moderate" patient population, noting that while some oral therapies have broader labels for less severe disease, recent head-to-head trials show that many patients find the convenience of an injection every three months to be superior to a daily pill. The discussion concludes by reaffirming that because every patient defines convenience and success differently, a personalized, conversational approach is the only way to optimize long-term adherence and outcomes.

The next episode in this series, ‘Emerging Updates in Psoriasis from 2026 AAD Annual Meeting,’ features the panelists discussing late-breaking data regarding next-generation oral therapies and the dramatic synergy between weight-loss medications and psoriasis treatments. Dr. Bhutani-Jacques and Dr. Lebwohl explore how these combined approaches significantly improve skin clearance and systemic health.