Systemic agents such as methotrexate and cyclo-sporine are commonly used in the treatment of psoriasis. Long-term continuous use is not recommended due to potential organ toxicity, myelosuppression, and carcinogenicity. Abrupt cessation of systemic agents without tapering can lead to flare-up and rebound of psoriasis. The addition of a biologic agent during transitional therapy from a systemic agent is a good strategic maneuver to prevent a potential rebound complication. Even with a gradual cessation of systemic agents, the psoriasis will eventually relapse if biologic agents are not added to the treatment regimen. No additional toxicities or adverse events are evident during combination therapy with a systemic agent and a biologic agent.