Learning From Success and Failure: Biologics for Non-approved Skin Diseases

The impressive potential of biologics has been demonstrated in psoriasis, hidradenitis suppurativa and urticaria. Numerous biologicals are entering the field for a restricted number of skin disorders. Off-label use of biologics in other recalcitrant skin diseases has increased. Mounting data point to the potential of already existing biologics acting on the IL-17/IL-23 pathway in skin disorders with epidermal hyperkeratosis (e.g. pityriasis rubra pilaris), acneiform inflammation (e.g. hidradenitis suppurativa) and loss of mucosal integrity (e.g. aphthosis). TNF-α blockers are also effective in the latter conditions but seem of particular value in granulomatous (e.g. granuloma annulare) and neutrophilic disorders (e.g. pyoderma gangrenosum). Failure of IL-17 blockade in skin diseases resulting from immune-mediated cell destruction (e.g. alopecia areata and vitiligo) illustrates its limited involvement in Th1-dependent skin immunology. Overall, disappointing results of TNF-α blockers in alopecia areata and vitiligo point to the same conclusion although promising results in toxic epidermal necrolysis suggest TNF-α exerts at least some in vivo Th1-related activities. Acting on both the Th1 and Th17 pathway, ustekinumab has a rather broad potential with interesting results in lupus and alopecia areata. The efficacy of omalizumab in bullous pemphigoid has revealed an IgE-mediated recruitment of eosinophils leading to bullae formation. Reconsidering reimbursement criteria for les...
Source: Frontiers in Immunology - Category: Allergy & Immunology Source Type: research