Therapeutics & Phototherapy (incl. biologics)

A 28-year-old woman with generalized vitiligo (8% BSA) asks about light therapy. She is not pregnant. What is the first-line phototherapy?

A man with severe plaque psoriasis wants rapid control for an upcoming wedding in 6 weeks. Which systemic offers the fastest onset for flares?

A 34-year-old woman with chronic plaque psoriasis and class II obesity is considering methotrexate. Key baseline steps?

A 55-year-old with long-standing psoriasis and NYHA class III heart failure asks about biologics. Which class should be avoided?

A 40-year-old with subacute cutaneous lupus seeks phototherapy for pruritus. Best answer?

A 62-year-old with actinic keratoses on scalp prefers field therapy with minimal pain. Best option?

A 29-year-old on isotretinoin 0.6 mg/kg/day asks about labs. Reasonable monitoring?

A 33-year-old woman on acitretin for palmoplantar psoriasis asks about family planning. Counseling?

A 45-year-old with plaque psoriasis asks about ustekinumab dosing. Key principle?

A 50-year-old with psoriasis and prior latent TB (treated) is starting a biologic. Which screening is still appropriate?

A 37-year-old with psoriasis and Crohn disease seeks a biologic helpful to both. Best class?

A patient on an IL-17 inhibitor develops recurrent oral thrush. Why?

A 24-year-old with severe atopic dermatitis starts dupilumab. Common adverse effect to counsel?

A 16-year-old with widespread AD needs systemic therapy. Which is pregnancy-safe and often used short-term for flares?

A 61-year-old with psoriasis undergoes PUVA. Long-term risk to discuss?

A 48-year-old on methotrexate develops oral ulcers after starting TMP-SMX for UTI. Mechanism?

A 30-year-old with chronic hand eczema asks about NB-UVB during pregnancy. Best answer?

Pre-biologic vaccination advice includes:

A 33-year-old with psoriasis starts apremilast. What to monitor/counsel?

A patient on infliximab develops fever, arthralgia, and urticaria during infusion. Best acute step?

A 42-year-old with morphea has severe inflammatory activity. Which phototherapy is most useful?

A man with psoriasis asks about Goeckerman therapy. What is it?

A 27-year-old with hidradenitis suppurativa (Hurley II) failed tetracyclines. Biologic with strongest evidence?

During PUVA, which protective step reduces genital SCC risk in men?

A 52-year-old on cyclosporine for erythrodermic psoriasis shows BP 165/98 mmHg and creatinine rising. Next step?

Before starting methotrexate in a patient with NAFLD and obesity, which tool can help stratify hepatic risk?

A 36-year-old with plaque psoriasis and past optic neuritis seeks biologic therapy. Which to avoid?

A 25-year-old female with hormonal acne is started on spironolactone 100 mg/day. Key counseling?

A 43-year-old with extensive chronic plaque psoriasis prefers infrequent dosing and minimal infection risk. Which class fits best?

A patient with widespread psoriasis is on systemic steroids for another condition. Risk when tapering?

A 58-year-old with chronic hepatitis B surface antigen positivity needs a biologic for psoriasis. Best strategy?

Which site repigments best during NB-UVB for vitiligo?

A 35-year-old with AD uncontrolled on optimized topicals tried phototherapy with partial relief. Next advanced option with strong evidence?

A 28-year-old on upadacitinib for AD asks about safety. Core boxed warnings cover:

A patient with psoriasis on biologic is scheduled for an elective major surgery. General perioperative advice?

A 47-year-old with hundreds of AKs wants a once-daily topical alternative to 5-FU. Newer option?

A 32-year-old on IL-17 inhibitor asks about GI history screening. Why?

A 60-year-old with erythrodermic psoriasis cannot tolerate cyclosporine and MTX. Which fast-acting biologic option is commonly used?

A 44-year-old gets symptomatic erythema (painful red, not blistering) after NB-UVB. Dosing adjustment?

During PUVA courses, which eye protection is mandatory and for how long on treatment days?