Old-School Systemics Still Pack a Punch

At Fall Clinical PA/NP 2025, Kristine Kucera, PA-C, MPAS, DHS, presented a timely and clinically relevant discussion on the enduring value of traditional systemic therapies in dermatology. A practicing physician assistant at Bare Dermatology in Dallas, Texas, and a member of the advisory council for DermSquared, Kucera emphasized that despite the influx of novel biologics and targeted therapies, older systemic medications still hold a significant place in dermatologic care.

Kucera's session explored the clinical utility of traditional systemics—such as methotrexate, acitretin, and cyclosporine—in treating a range of dermatologic conditions beyond their well-known applications in psoriasis and psoriatic arthritis. Drawing on published case studies, she highlighted the broader efficacy of these medications across multiple inflammatory skin diseases, including conditions where newer agents may not yet be approved or accessible.

A major focus of her talk was the practical knowledge required to use these medications safely and effectively. She underscored the importance of understanding each drug’s mechanism of action, contraindications, and potential drug interactions. For example, cyclosporine’s extensive interaction profile demands close attention to a patient’s existing medication regimen, while methotrexate use requires screening for hepatic and renal comorbidities.

Kucera also addressed the common barrier posed by insurance requirements. In many cases, insurance providers mandate that patients “fail” an older systemic medication before approving coverage for newer, often more expensive, biologics. This necessitates a working proficiency with traditional agents among dermatology providers, particularly for physician assistants and nurse practitioners managing frontline care.

Additionally, Kucera encouraged attendees to engage in continued education through conferences such as Fall Clinical and the Inflammatory Disease Summit. These events, she noted, offer in-depth, case-based learning on both classic and emerging therapies, as well as comprehensive coverage of medical, surgical, and aesthetic dermatology.

Her presentation served as a reminder that while innovation in dermatology is exciting, clinical decision-making must remain grounded in a deep understanding of all available therapeutic options, including the time-tested systemics that continue to provide value in specific patient populations.

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