Case 2: Simplifying Therapy for Scalp and Body Psoriasis

In this episode, Dr. Tina Bhutani-Jacques presents the second case, featuring a 45-year-old woman with plaque psoriasis affecting both the scalp and body. The patient has 12% body surface area involvement and reports persistent pruritus, flaking, and visible plaques that negatively impact her confidence in both social and professional settings. Despite previous treatment with multiple topical corticosteroids and medicated shampoos, she continues to experience inadequate disease control due to difficulties with application, cosmetic concerns related to greasy formulations, and confusion associated with using different therapies for different body sites.

Dr. Bhutani-Jacques discusses the unique challenges of managing psoriasis in hair-bearing areas such as the scalp, where treatment selection is influenced not only by efficacy but also by vehicle formulation, ease of application, and patient preference. She explains that while creams and ointments may be appropriate for body lesions, scalp psoriasis often requires more cosmetically acceptable vehicles, such as foams, solutions, or gels, to encourage consistent use. Importantly, she emphasizes that prescribing multiple products for different body regions can increase treatment complexity, reduce adherence, and ultimately compromise long-term disease control.

To address these challenges, Dr. Bhutani-Jacques highlights the importance of simplifying treatment regimens whenever possible. For this patient, the decision was made to initiate roflumilast 0.3% foam, a nonsteroidal topical therapy approved for use on both the scalp and body. She explains that using a single once-daily therapy across multiple affected areas can reduce confusion, improve adherence, and better align treatment with patient preferences. The case underscores the value of individualized treatment selection, thoughtful vehicle choice, and regimen simplification to optimize outcomes and quality of life for patients with plaque psoriasis.

In the next episode, "Why One Foam Works for Scalp and Body Psoriasis," Dr. Bhutani-Jacques expands on why this particular foam formulation suits a patient with both scalp and body disease and outlines her follow-up schedule for monitoring response.