Send us Fan Mail

Psoriasis Part 2: Differentials, Psoriatic Arthritis Screening, and the Psoriasis Treatment Ladder | The Derm Resident

Contact: thedermresident.pod@gmail.com

Hosts Dr. Jonny Hatch and Dr. Deven Curtis continue psoriasis with a focus on chronic plaque differentials, psoriatic arthritis, and a practical treatment ladder. They review mimickers including seborrheic dermatitis and lichen simplex chronicus (including “sebo-psoriasis”), mycosis fungoides prompting biopsy when plaques are treatment-resistant or atrophic, hypertrophic lichen planus on shins, and guttate-pattern differentials such as pityriasis rosea, pityriasis lichenoides chronica, and secondary syphilis. They emphasize screening for psoriatic arthritis (about one-third of patients; HLA-B27 association) using joint/back pain history, nail findings, and dactylitis, with rheumatology referral when appropriate. Treatments covered include topical steroids by site, calcipotriene, tazarotene, roflumilast foam, tapinarof, phototherapy (narrowband UVB preferred over PUVA), and systemic therapies (methotrexate with folate, cyclosporine, apremilast, acitretin) plus biologics (TNF, IL-17, IL-23, ustekinumab) and deucravacitinib, along with biologic prescreening (TB, hepatitis, CBC/CMP, vaccine counseling) and psoriasis comorbidity risks.

00:00 Show Intro and Disclaimer
00:29 Plaque Psoriasis Differentials
02:21 Guttate Mimickers
03:25 Screening for Psoriatic Arthritis
04:53 Topical Treatment Basics
06:32 Nonsteroid Topicals and New Agents
08:13 Phototherapy UVB and PUVA
10:45 Systemics Methotrexate Deep Dive
13:45 Cyclosporine and Oral Options
18:11 Biologics TNF Alpha Inhibitors
22:41 IL-17 Inhibitors Key Pearls
25:47 IL-23 and IL-12/23 Therapies
28:23 Deucravacitinib and Biologic Workup
30:46 Psoriasis as Systemic Disease
31:32 Closing Pearls and Wrap Up

This episode is sponsored by Mind the Skin, a patent-pending, steroid-free, patch system. Learn more at mindtheskinlabs.com. Use code TDRP26 at checkout for 20% off.