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 (Fig. 4c).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 rheumatologists stated that their hesitation to prescribe systemic therapy was related to tolerability and long-term safety concerns. Among the respondents, 53.0% of dermatologists and 30.5% of rheumatologists agreed that keeping a patient's symptoms at bay was the best the patients could expect from conventional oral therapy; 49.6% and 27.7%, respectively, felt that patients leaving their practice due to frustration or dissatisfaction with currently available therapies is an important issue; and 26.3% and 13.3%, respectively, felt the treatment options could be worse than the condition itself. The most important attributes of an ideal therapy, identified by the respondents, were largely related to efficacy and safety, which generally mirrored what they considered the greatest unmet therapeutic needs (Table 3). In addition, improved access to therapy and oral administration were among the five most commonly selected attributes; another oral option and new mechanism of action were among the five most commonly noted unmet therapeutic needs. MAPP is a unique large-scale, multinational survey containing both a patient and physician component aimed at gaining a better understanding of global perspectives on the burden of psoriasis and PsA and their treatment. Results from the multinational patient survey showed a significant burden of disease and unmet treatment needs.8 We report the findings from the physician portion of the survey, which included dermatologists and rheumatologists who care for patients with psoriasis and/or PsA. These findings largely support those of the patient survey, including a large disease burden, underdiagnosis of PsA, differing perceptions of disease severity and challenges with current treatment options. While dermatologists and rheumatologists recognized the emotional and social toll that psoriasis and PsA may place on patients, most acknowledged that the burden of disease is often underestimated. Dermatologists estimated that 20% of their psoriasis patients and 26% of their PsA patients had severe disease. In the patient portion of the MAPP survey, slightly more psoriasis patients (27%) and twice as many PsA patients (53%) rated their disease as severe.8 Reasons for the disconnect may be related to the use of standardized tools by physicians vs. more subjective assessments by patients. In addition, patients and physicians were not matched, so results cannot be directly compared. However, physicians and patients