Keki Mody

A systemic-naive roofer with extensive plaque psoriasis and cardiometabolic risk illustrates why compliance history, not just disease severity, should shape the first conversation about moving beyond topical therapy.

As biologics multiply, the boundary between topical failure and systemic eligibility remains contested. Dr. Armstrong outlines the severity thresholds, comorbidities, and quality-of-life factors that most reliably justify escalating plaque psoriasis therapy.