Age alone is not a contraindication to biologic therapy for psoriasis, yet clinicians continue to withhold these agents from elderly patients based on safety assumptions that the evidence does not support, according to a Dermatology Times examination of biologic safety myths in older psoriasis patients.

The piece addresses a persistent clinical tension: dermatologists treat a growing population of psoriasis patients over 65 while carrying reservations about initiating systemic biologics in that cohort. Those reservations, the article argues, frequently trace back to myths rather than to trial data or real-world registry findings.

What myths surround biologics in older patients?

The Dermatology Times report identifies several recurring misconceptions that shape prescribing behavior in geriatric dermatology. Among them: the belief that biologics carry an outsized infection risk in the elderly, that comorbidities and polypharmacy make biologic initiation inherently hazardous, and that older patients derive less benefit from these agents than younger patients do.

Each assumption deserves scrutiny on its own terms. The article's central argument is that clinicians should evaluate biologic candidacy in older psoriasis patients the same way they do in any other population — by weighing the patient's infection history, comorbidity burden, vaccination status and concomitant medications individually, rather than defaulting to age-based exclusion.

Why does this matter for psoriasis care?

Psoriasis in elderly patients is not a rare clinical scenario. As the population ages, dermatologists face more patients whose disease has persisted for decades or whose plaques have become diffuse and recalcitrant to topicals. Phototherapy may be impractical for patients with mobility limitations, and traditional systemic agents such as methotrexate pose tolerability problems in older adults, including hepatic and renal considerations that tighten monitoring requirements.

That leaves a therapeutic gap that biologics are well positioned to fill — provided clinicians move past the safety hesitancy the article works to dismantle. Untreated or undertreated psoriasis carries its own risks in this population, from impaired quality of life to psoriatic arthritis progression, and the article frames excessive caution as a harm in its own right rather than a neutral default.

How should clinicians approach the decision?

The Dermatology Times piece positions shared decision-making as the practical pathway forward. That means:

• Screening for latent infection and updating vaccinations before initiation, as standard practice already dictates
• Reviewing the full medication list for interactions and immunosuppressive overlap
• Discussing the patient's goals of therapy, life expectancy and treatment burden openly
• Selecting agents and dosing intervals with the patient's functional status in mind

None of these steps is unique to geriatric prescribing. The article's point is precisely that the framework already exists — what needs revision is the reflexive assumption that biologics belong on the wrong side of the risk-benefit ledger for older adults.

What comes next?

As biologic indications expand and long-term registry accrual deepens, the evidence base specific to patients over 65 will continue to mature, giving dermatologists sharper tools to individualize — rather than mythologize — biologic safety conversations in the clinic.