Module 13: Emerging Therapies and Current Guidelines in Dermatology

Learning Objectives

By the end of this module, students should be able to:

Describe the principles and indications of emerging therapies, including biologics and targeted small molecules, across common dermatological diseases.
Summarize recent advances and current clinical guidelines for the management of key chronic dermatological conditions.
Understand patient selection, monitoring requirements, and safety considerations for biologics and novel therapies.
Apply knowledge of evolving therapies in clinical decision-making and evidence-based practice.
Recognize the importance of multidisciplinary care and treatment guidelines in dermatology.

1. Introduction to Emerging Therapies in Dermatology

Modern treatments focus on immune pathways and molecular targets in dermatologic diseases.
Biologics: monoclonal antibodies targeting cytokines or cell surface markers.
Small molecule inhibitors: oral agents targeting intracellular signalling pathways.

2. Biologics and Targeted Therapies: Applications and Mechanisms

Psoriasis and Psoriatic Arthritis

IL-17 and IL-23 inhibitors are preferred for biologic-naive patients with moderate-to-severe disease.

Biologics targeting TNF-α (e.g., adalimumab, etanercept).
IL-12/23 inhibitors (e.g., ustekinumab).
IL-17 inhibitors (e.g., secukinumab, ixekizumab).
IL-23 inhibitors (e.g., guselkumab, risankizumab).
JAK inhibitors under investigation.

Atopic Dermatitis

Dupilumab is now recommended for moderate-to-severe cases unresponsive to topical therapy.

Dupilumab: IL-4 receptor α antagonist blocking IL-4 and IL-13 signalling.
Emerging agents: tralokinumab (anti-IL-13), JAK inhibitors (baricitinib, upadacitinib).

Hidradenitis Suppurativa

Biologics targeting TNF-α (adalimumab) with ongoing trials for IL-17 and IL-1 blockers.

Alopecia Areata

JAK inhibitors (tofacitinib, ruxolitinib) are showing efficacy in hair regrowth.

3. Latest Clinical Guidelines Highlights (2024–2025)

Psoriasis: Guidelines (e.g., American Academy of Dermatology [AAD], National Psoriasis Foundation) recommend biologics based on severity, comorbidities, and patient preference. Emphasize early intervention in moderate-to-severe disease. IL-17 and IL-23 inhibitors are preferred for biologic-naive patients with moderate-to-severe disease.
Atopic Dermatitis: Updated consensus recommends dupilumab for moderate-to-severe AD not controlled with topical therapy. Systemic immunosuppressants for select cases.
Skin Cancer: NCCN guidelines updated for melanoma immunotherapy, including checkpoint inhibitors (nivolumab, pembrolizumab).
Monitoring: Guidelines stress screening for latent infections (TB, hepatitis), malignancy risk, and regular assessment of response and adverse effects when using biologics.

4. Safety and Monitoring

Pre-treatment screening: TB (IGRA), hepatitis B/C, latent infections.
Infection risk and immunization: Ensure vaccinations are up to date before initiating immunosuppressive therapy.
Laboratory monitoring: Regular blood tests and patient education about signs of infection or adverse reactions.
Multidisciplinary approach: Involving dermatologists, rheumatologists, and primary care.

5. Future Directions

Personalized medicine approaches.
Biomarkers guiding treatment choice and prognosis.
Combination therapies and novel agents in clinical trials.

Multiple Choice Questions

Tap an answer to check yourself — the correct option and an explanation appear once you choose.

Q1 Which cytokine is the primary target of dupilumab in atopic dermatitis?

Q2 Which biologic is approved for moderate-to-severe plaque psoriasis and targets IL-17?

Q3 Before starting a TNF-α inhibitor, which screening test is mandatory?

Short Answer Questions

SAQ 1: Indications for Biologic Therapy in Psoriasis

SAQ

List three indications for biologic therapy in patients with psoriasis.

Reveal model answer

Model answer

Moderate-to-severe plaque psoriasis not responding to topical or conventional systemic therapy.
Psoriatic arthritis with active joint inflammation.
Significant impact on quality of life or contraindications to traditional systemic agents.

SAQ 2: Safety Concerns with Biologic Therapies

SAQ

Describe two common safety concerns with biologic therapies in dermatology.

Reveal model answer

Model answer

Increased infection risk, including reactivation of latent tuberculosis — hence the mandatory pre-treatment TB screening with IGRA or chest X-ray.
Injection site reactions or hypersensitivity — patients should be educated to report local reactions; rare risks include malignancies or demyelinating diseases depending on the specific agent.

OSCE Station

OSCE 1: Counselling for Biologic Therapy in Psoriasis

OSCE

Scenario: A 34-year-old man with severe plaque psoriasis is referred for consideration of biologic therapy. You are tasked with counselling him during the clinic visit.

Task: Take a focused history including previous treatments and comorbidities, explain the role, benefits, risks, and monitoring of biologic therapy, and discuss the importance of screening tests before starting and ongoing follow-up.

Self-assess against checklist

Tick each point you covered, then check your score.

Elicits treatment history: previous topical and systemic therapies tried, response, and reasons for escalation.
Elicits disease impact on quality of life and any comorbidities (e.g., psoriatic arthritis).
Explains in simple terms that biologics target specific immune pathways (cytokines) driving psoriasis.
States that biologics can clear skin and control inflammation more effectively than prior treatments.
Explains mandatory pre-treatment screening, specifically TB (IGRA or chest X-ray) and hepatitis B/C.
Describes route of administration: subcutaneous injections given on a regular schedule.
Informs about infection risk and advises patient to report signs of infection promptly.
Mentions possible injection site reactions and rare adverse effects.
Explains routine laboratory monitoring and follow-up schedule.
Provides reassurance and invites patient questions.