with the use of conventional oral DMARD therapy, or reported using it sparingly (20.5%), whereas most rheumatologists (68.5%) reported that they felt conventional oral therapy provided benefit and used it broadly and only 9.0% used it sparingly. Reasons for not initiating (Fig. 3a) or continuing (Fig. 3b) oral therapy were often related to long-term safety and tolerability concerns. In addition, 18.7% of dermatologists and 16.1% of rheumatologists said patient contraindications were a main factor in preventing greater use of conventional oral therapies. Rheumatologists commonly cited lack of response as a limitation to continuing therapy (35.4%). For dermatologists and rheumatologists who held back prescribing oral therapy because of patient refusal or concerns, the most common reasons were related to tolerability, long-term safety, lifestyle modifications and lack or loss of response.Top five most commonly cited limitations for initiating conventional oral therapy (a), continuing conventional oral therapy (b) and patient concerns regarding the use of conventional oral therapy (c).Approximately 40% of dermatologists and rheumatologists were comfortable, but conservative, in their use of biologic therapy. More rheumatologists (41.5%) reported aggressive use compared with dermatologists (19.9%), and a greater proportion of dermatologists (10.5%) reported not prescribing biologics compared with rheumatologists (1.8%). Among dermatologists, 65.5% said they would initiate and manage the biologic therapy themselves, compared with 90.3% of rheumatologists. The main reasons for not initiating biologics were related to cost and long-term safety and tolerability concerns (Fig. 4a). Rheumatologists commonly cited lack or loss of response as a limitation to continuing therapy (Fig. 4b). Long-term safety was more commonly reported as a limitation to initiating biologics by dermatologists and rheumatologists from North America (32.6% and 54.5% respectively) compared with Europe (13.6% and 17.0% respectively). Biologic therapy-related tasks most commonly considered burdensome included prior authorization paperwork; ensuring patients comply with laboratory results; handling patient calls regarding questions or possible side-effects; teaching self-injection; and discussing with patients the use of and risks associated with injectable biologic therapy.Top five most commonly cited limitations for initiating (a) and continuing (b) patients on biologic therapy and burdensome tasks/steps associated with biologic therapy (c).While most dermatologists were somewhat or very satisfied with the effectiveness of conventional oral (84.2%) or biologic therapy (95.9%), 27.8% and 25.6% were somewhat/very dissatisfied with their long-term safety, respectively, and 75.4% and 83.4% expressed concern about the health risks of their long-term use. Likewise, most rheumatologists were somewhat/very satisfied with the efficacy of currently available therapies (conventional oral therapy: 81.8%; biologics: 97.9%). Concern regarding the long-term safety of oral and biologic therapies was reported by 11.3% and 15.4%, of rheumatologists respectively. However, 53.6% and 68.5% of rheumatologists reported being somewhat/very concerned with the health risks of long-term use of oral or biologic therapies respectively. When prescribing topical therapy for psoriasis patients eligible for oral or biologic therapy, 7.9% of