To the Editor A recent study¹ evaluating the safety and efficacy of roflumilast cream, 0.3%, for chronic plaque psoriasis involving 2% to 20% of body surface area concluded that daily use of roflumilast cream for 8 weeks was more effective than vehicle cream. We would like to point out some limitations of this study that decrease its generalizability.

First, only 36.3% of patients in this study¹ were female despite evidence that women constitute more than 50% of all patients with psoriasis.² In addition, females with psoriasis are more likely than males to use topical treatments, such as roflumilast cream.³ Therefore, having a representative population in clinical trial studies for topical psoriasis therapies would be beneficial, as many topical therapy users will be female.