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Biologic Perioperative — SCE Dermatology MCQ

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ModerateDermatopharmacologyBiologic PerioperativeSCE Dermatology

A 55-year-old woman with psoriasis has been stable on Adalimumab for 3 years. She requires elective total knee replacement. What is the recommended approach to her biologic therapy perioperatively?

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Correct answer: B — Withhold Adalimumab for 3-5 half-lives before surgery (approximately 4-6 weeks for Adalimumab) and restart once wound healing is satisfactory

BSR/BAD guidelines recommend withholding biologic therapy before elective surgery for a period based on the drug's half-life (typically 3-5 half-lives) to reduce perioperative infection risk. For Adalimumab (half-life approximately 14 days), this means withholding for approximately 4-6 weeks before surgery. The biologic should be restarted once wound healing is satisfactory and there is no evidence of infection (typically 2-4 weeks postoperatively). The decision should be made jointly by the dermatologist, surgeon, and anaesthetist. Minor procedures (skin surgery under local anaesthesia) generally do not require biologic interruption. The psoriasis may flare during the drug-free period.

Reference: BAD 2020 Biologic Guidelines; BSR 2016 Perioperative