Counseling Patients on Switching to Non-Steroidal Psoriasis Treatment

In this segment, Dr. Tina Bhutani-Jacques discusses the clinical rationale for transitioning patients with plaque psoriasis to newer nonsteroidal topical therapies when previous treatments have provided inadequate efficacy or tolerability. Using the first patient case, she explains how involvement of sensitive, intertriginous areas, incomplete disease control with topical corticosteroids, and prior intolerance to a vitamin D analog supported the decision to switch to roflumilast 0.3% cream rather than continue therapies that had already produced suboptimal outcomes. Dr. Bhutani-Jacques emphasizes the importance of considering lesion location, prior treatment response, and patient experience when selecting a topical therapy.

The discussion then shifts to patient counseling and strategies for improving confidence in treatment after previous disappointments. Dr. Bhutani-Jacques notes that many patients become discouraged after trying multiple topical therapies without achieving satisfactory disease control. She highlights the value of spending additional time educating patients about advances in nonsteroidal topical therapies, including their demonstrated efficacy, potential for improvement within four to eight weeks, convenient once-daily dosing, and more elegant formulations designed to enhance patient comfort and adherence. By comparing advances in topical medications to the continual evolution of everyday technology, she illustrates how thoughtful counseling can help patients become more engaged in their treatment.

Finally, Dr. Bhutani-Jacques reviews the importance of ongoing follow-up and reassessment after initiating therapy. While newer nonsteroidal topical agents have expanded treatment options, she stresses that clinicians should continue monitoring response and tolerability, with reevaluation after three to six months. If patients fail to achieve adequate disease control or continue to experience treatment-related challenges, clinicians should initiate a discussion about escalating to systemic therapy to optimize long-term disease management.

In the next episode, "Case 2: Simplifying Therapy for Scalp and Body Psoriasis," Dr. Bhutani-Jacques introduces Case 2, a woman managing psoriasis on both her scalp and body who's struggled to keep two different regimens straight.