How do you approach management of a patient with coexisting psoriasis and systemic sclerosis, particularly when both active psoriasis and skin tightening are present?  

It depends if both diseases are considered significant and active. If so, a JAK-inhibitor would kill two birds with one stone. JAK's are already approved for psoriatic arthritis, and there is decent data for skin psoriasis as well, on par with some of our currently FDA-approved therapies. There ...

Narrow-band UVB would be a fantastic option for a patient like this, as I would expect it to help both issues significantly. Agree with Dr. @Min that other therapies may be required to manage other issues if present (like ILD), but most can be used concurrently with phototherapy.