Case 1: Choosing Non-Steroidal Topicals for Intertriginous Psoriasis

In the first case discussion, Dr. Tina Bhutani-Jacques presents a 48-year-old man with chronic plaque psoriasis who has experienced disease progression into intertriginous areas despite partial control with topical therapies. The patient reports persistent symptoms, concerns about long-term corticosteroid use in sensitive areas, difficulty managing multiple topical products, and a preference to avoid systemic therapy. Dr. Bhutani-Jacques uses this case to illustrate the importance of evaluating not only body surface area but also lesion location, symptom burden, treatment adherence, and patient preferences when assessing disease control and selecting therapy.

The discussion highlights the unique challenges of treating psoriasis in intertriginous regions, where thinner, more sensitive skin increases the risk of adverse effects from prolonged topical corticosteroid use. Dr. Bhutani-Jacques reviews the role of nonsteroidal topical therapies, including calcineurin inhibitors, vitamin D analogs, roflumilast, and tapinarof, as long-term treatment options that may be better suited for these difficult-to-treat areas. She also emphasizes the need to recognize when patients become trapped in the "topical treatment cycle" and discusses when it may be appropriate to consider escalation to systemic therapy.

Following the case, Dr. Bhutani-Jacques explains the rationale for transitioning the patient to roflumilast 0.3% cream, highlighting its ability to treat multiple body sites with a single therapy. She concludes by discussing the recent FDA label expansion of roflumilast 0.3% cream for pediatric patients aged 2 years and older with chronic plaque psoriasis, noting that this expanded indication reinforces confidence in the medication's safety profile and broadens treatment options for both pediatric and adult patients.

In the next episode, "Counseling Patients on Switching to Non-Steroidal Psoriasis Treatment," Dr. Bhutani-Jacques continues Case 1, explaining exactly which clinical factors justified the switch and how she counsels patients who've been burned by ineffective treatment before.