ABSTRACT
The skin is the largest organ in the human body. It is also anatomically varied in its structure and function. Both the underlying disease and the inherent site-specific differences influence the manifestations of skin disorders. This chapter begins by briefly outlining general concepts in the development, delivery and application, and efficacy and safety of drugs in skin disorders. This is followed by discussions on the use of existing drugs for the treatment of specific skin diseases. Several new advances in the treatment of skin disorders have been made in recent years. An important area of change has been the use of immunosuppressive agents and targeted immunebased therapies. Topical diclofenac, 5-fluorouracil, imidazoquinolines, and photodynamic therapy are the nonsurgical therapeutic armaments currently available for the treatment of premalignant and malignant skin disorders. In acne, therapy with antimicrobials, retinoids, and hormonal manipulation is currently used. Often, combination therapy is required for effective treatment. Psoriasis and two rare inflammatory dermatoses — pyoderma gangrenosum and toxic epidermal necrolysis — are also discussed, as these conditions illustrate the shift in dermatology treatment strategies toward targeted immune-based therapies. Psoriasis in the past has generally been managed with topical treatment, but more recently immunosuppressives such as methotrexate, cyclosporine, acitretin, and fumaric acid esters have been found to be highly effective. Targeted immune-based therapies such as the use of infliximab, etanercept, and other biologics are also highlighted. Intravenous immunoglobulin therapy is discussed in the treatment of toxic epidermal necrolysis.
