At the 2026 American Academy of Dermatology (AAD) Annual Meeting, several experts discussed important considerations surrounding the prescribing of systemic agents for psoriasis. Addressing common myths about the use of these therapies was the focus of one of these presentations.

Following this presentation, featured expert Jennifer Soung, MD, was interviewed by Conference Reporter Associate Editor-in-Chief Rick Davis, MS, RPh. Clinical perspectives from Dr Soung on these findings are presented here.

Mona Shahriari, MD, FAAD, organized her talk at the recent 2026 AAD Annual Meeting as a myth-busting presentation on safe prescribing in psoriatic disease. The first myth she addressed is that all biologic therapies for psoriasis require screening for tuberculosis (TB) at baseline and annually thereafter. Recently, the National Psoriasis Foundation (NPF) Medical Board and the International Psoriasis Council (IPC) wrote a joint position paper stating that the available data for IL-17 and IL-23 inhibitors show no widespread reactivation of latent TB. Therefore, routine testing for latent TB infection is no longer required prior to or during treatment with IL-17 or IL-23 inhibitors.

This is clinically significant, as excessive testing may contribute to unnecessary patient morbidity, including exposure to medications that are not indicated, and increased health care costs. In addition, such testing is often leveraged by insurers as a barrier during the prior authorization process. Based on the available evidence, we are now better positioned to advocate against routine screening in all patients and to promote a more evidence-based, individualized approach to care.

The second myth, as discussed by Dr Shahriari, is that all biologic therapies must be discontinued during preconception or pregnancy. However, in practice, most patients with psoriasis experience an improvement in disease activity during pregnancy, and the continuation of therapy is not universally contraindicated.

Management should be individualized, incorporating shared decision making based on patient preferences and clinical context. In patients who enter pregnancy with well-controlled disease, a common approach is to discontinue the biologic once pregnancy is confirmed. Given that time to disease recurrence may extend to approximately 6 months or longer with IL-17 and IL-23 inhibitors, this strategy may allow for adequate disease control throughout much of the pregnancy. Biologic therapy can then be resumed post partum, as there is no established contraindication to use during breastfeeding.

The third myth she addressed is that biologics cause cancer and should not be used in patients with a history of malignancy. Multiple meta-analyses have demonstrated no increased overall risk of malignancy associated with IL-17 and IL-23 inhibitors. Notably, clinical trials evaluating these agents typically enrolled patients with a history of cancer in remission for at least 5 years.

Again, in practice, management should be individualized and guided by shared decision making between the patient and their oncologist. In cases in which patients are receiving targeted therapies for solid organ malignancies, many oncologists are amenable to the continuation of biologic treatment. Importantly, these data support that the discontinuation of biologic therapy is not universally required in all clinical scenarios.

The fourth myth that was discussed by Dr Shahriari at the 2026 AAD Annual Meeting is that biologic therapy for psoriasis must be discontinued prior to major surgery. However, current guidance from the NPF supports the continuation of biologic agents in the perioperative setting, particularly IL-17 and IL-23 inhibitors.

That said, management should still remain individualized. In higher-risk or complex surgical procedures, perioperative decisions are often directed by the surgical team. Reassuringly, many of these therapies provide durable disease control, and, even when treatment is temporarily held, time to recurrence is typically on the order of months rather than weeks.

Finally, the fifth myth is that biosimilars for psoriasis are less safe than branded biologics. This is false. The US Food and Drug Administration (FDA) has a rigorous process for getting biosimilars approved. There are anecdotes that biosimilars do not perform as well as the branded drugs. However, in terms of safety, the only way to get a biosimilar approved by the FDA is through a rigorous safety evaluation process. We are trying to demystify this issue because, in some areas of the United States, the use of available biosimilars is required prior to accessing branded biologics.