Dermatological pharmacology: systemic drugs

Systemic treatment of skin disease is changing rapidly: we are at the dawn of a new era of targeted therapy that is emerging against the background of a clearer understanding of the molecular pathogenesis of common dermatoses and skin cancer. Biological agents and new oral therapies are being developed specifically against the underlying immune abnormalities in common inflammatory skin diseases, especially psoriasis. Biologics are now also indicated for urticaria and hidradenitis suppurativa, and treatment for atopic dermatitis is imminent. These drugs are restricted to severe disease, so conventional systemic therapy with immunosuppressants and anti-inflammatory drugs still plays a major role in the management of skin disease. The very poor prognosis of advanced melanoma has for the first time been improved by new immune and molecularly targeted therapy, although the optimum way of using these drugs remains to be decided.