Psoriasis in Practice: Refreshing the Topical Toolbox

At Dermatology Week APP Day 2025, Laura Bush, DMSc, PA-C, DFAAPA, delivered a practical and fast-paced session titled “Psoriasis in Practice: Current Advances in Everyday Management for NPs and PAs.” Packed with pearls for daily use, the session focused on where topicals still shine, how phototherapy fits in, and why new nonsteroidal options are changing the game.

“Topicals are still first line,” Bush said, “but we’ve got more tools now and better reasons to use them smartly.”

She opened with a nod to phototherapy, calling it “old but gold” and especially valuable in guttate flares, pregnancy, or widespread disease. Narrowband UVB, she noted, remains safe, non-immunosuppressive, and effective—even when biologics stumble.

Topical steroids, vitamin D analogs, and calcineurin inhibitors still form the foundation for mild-to-moderate disease, but Bush spotlighted 2 recent additions: tapinarof and roflumilast.

Tapinarof, derived from soil bacteria, works via the aryl hydrocarbon receptor and shows sustained clearance beyond 12 weeks of treatment. Roflumilast, a PDE4 inhibitor now available in both cream and foam, stands out for its once-daily use and tolerability on sensitive areas, including the face, folds, and scalp.

“The foam is light, spreads easily and patients actually want to use it,” she said.

Bush also reminded attendees to know when to escalate: Consider systemics when body surface area exceeds 10%, quality of life is impaired, or symptoms remain uncontrolled after 8 weeks.

She closed with a brief look at what’s next in topical innovation, including a topical IL-17 inhibitor currently in phase 2 trials. If successful, it could offer targeted psoriasis relief without systemic exposure.

The bottom line? Psoriasis care has never been more personalized or more promising. And for busy APPs, this session delivered a clear message: Know your options, simplify where you can, and treat the patient in front of you.

“It’s about the right treatment, for the right person, at the right time,” Bush said.

With more safe, flexible topicals on the market—and a few more on the horizon—this session gave attendees a practical roadmap for everyday success.

For more meeting coverage, visit the Dermatology Week APP Day newsroom.

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Reference

Bush L. Psoriasis in practice: Current advances and everyday management for NPs and PAs. Presented at: Dermatology Week; October 22–25, 2025; Virtual.