Citation

Wakelin S. Medicine (Abingdon) 2013; 41(6): 330-333.

Copyright

(Copyright © 2013, Medicine Publishing)

DOI

10.1016/j.mpmed.2013.04.019

PMID

unavailable

Abstract

In recent years there has been an evolution in the systemic therapy of skin disease, in particular immunosuppressive agents, retinoids and, most lately, biological drugs and new classes of drugs for advanced skin cancer. Developments in drug monitoring include measurement of thiopurine methyl transferase enzyme activity before prescribing azathioprine, to screen for patients at risk of severe bone marrow depression, and monitoring recipients of methotrexate with procollagen III peptide or Fibroscans to detect hepatic fibrosis. Biologics including anti-tumour necrosis factor α therapy offer a new and effective treatment for severe psoriasis in patients who have failed to respond to conventional systemic drugs, but risks include reactivation of tuberculosis. Oral retinoid therapy has expanded to include alitretinoin, a new oral drug for severe hand eczema, and stringent requirements have been introduced for females treated with isotretinoin due to the high risk of birth deformity which is common to these drugs. It is important that physicians are aware of the adverse effects of treatment and that patients are carefully selected screened and monitored to minimize any risk. © 2013 Elsevier Ltd. All rights reserved.

Language: en

Keywords

human; suicide; quality of life; nephrotoxicity; depression; acne; isotretinoin; article; neutropenia; priority journal; placebo; rheumatoid arthritis; drug efficacy; asthma; antihistaminic agent; corticosteroid; glucocorticoid; systemic lupus erythematosus; hypertension; side effect; hepatitis; hyperlipidemia; psoriasis; cancer risk; skin cancer; low drug dose; drug monitoring; drug indication; folic acid; azathioprine; pemphigus vulgaris; melanoma; immunosuppressive treatment; skin allergy; urticaria; immunosuppressive agent; mycophenolic acid 2 morpholinoethyl ester; toxic hepatitis; bullous skin disease; mood change; etretin; methotrexate; dermatological agent; dry skin; retinoid; systemic therapy; skin disease; cyclophosphamide; cyclosporin; infliximab; cancer chemotherapy; psoriasis vulgaris; adalimumab; progressive multifocal leukoencephalopathy; atopic dermatitis; basal cell carcinoma; hematologic malignancy; polymyositis; psoriatic arthritis; rituximab; corticosteroid therapy; drug dose escalation; Darier disease; tumor necrosis factor alpha inhibitor; cutaneous T cell lymphoma; omalizumab; biologics; acute febrile neutrophilic dermatosis; advanced skin malignancy; dermatomyositis; dermatoses; ichthyosis; immunosuppressive; pyoderma gangrenosum; retinoids; ustekinumab; vismodegib