The use of systemic agents is considered standard of care in patients with moderate to severe psoriasis, and these therapeutic agents are marked by a favorable risk-benefit profile, however, are plagued by high attrition. One questionnaire-based survey of 692 patients who had previously taken a biologic agent found that patients discontinued their medications after 11 to 20.5 months. 1 Our study aims to present additional real-world clinical data regarding the reasons behind discontinuation of these novel agents and the drug survival in an academic setting.A study cohort of 127 patients seen in a 5-year time frame at the departments of dermatology and/or rheumatology between June 2012 and April 2017 was identified by the following inclusion criteria: age greater than or equal to 18-years-old, visit diagnoses related to psoriasis and/or active psoriatic arthritis identified by ICD-9 and ICD-10 codes, and use of etanercept, adalimumab, infliximab, secukinumab, ustekinumab, or apremilast. Patients were excluded if Overall 444 (361, 525) Adalimumab 342 (280, 859) Infliximab 420 (223, 725) Etanercept 497 (364, 880) Secukinumab 504 (240, undecided) Ustekinumab 399 (278, 600) Apremilast 380 (274, 510)Note: P = .6893.

BACKGROUND Recent increase in skin biopsies has been attributed to an epidemic of skin cancer. This may be avoidable, with potential savings. OBJECTIVE To determine whether the increase in skin biopsies is attributable to increasing frequency of biopsies associated with histology lacking pathological cutaneous disease. Pathological cutaneous disease was defined as (1) a malignancy, precancerous lesion, or lesion of uncertain behavior; or (2) disease symptomatic or associated with adverse quality of life impact. PATIENTS AND METHODS Retrospective cohort study, 2006 to 2013 of dermatology practice serving Florida and Ohio. Data were a consecutive sample of skin biopsies for diagnosis of dermatologic disease. RESULTS A total of 267,706 biopsies by an average of 52 providers per month from January 06 to December 13 were analyzed. Number of biopsies per visit increased 2% per year (RR: 1.02, CI: 1.00–1.04). Likelihood of biopsy associated with histology indicative of nonpathological cutaneous disease did not increase over time (OR: 0.99, CI: 0.95–1.03, p = .6302). CONCLUSION Rates of biopsies associated with nonpathological cutaneous disease is not increasing. Overall biopsy rates per visit have gradually increased; this seems attributable to greater rates of detection of pathological dermatologic disease.