Biologic and small-molecule targeted therapies have reshaped dermatology practice over the past two decades, shifting severe inflammatory skin disease from a chronic, often disfiguring condition to one that's frequently manageable. Keeping the major drug classes straight, by target rather than by brand name, makes it easier to counsel patients and anticipate monitoring needs.

Organized by Molecular Target

TNF-α inhibitors (adalimumab, etanercept, infliximab) were the first biologic class widely used in dermatology, primarily for moderate-to-severe psoriasis, psoriatic arthritis, and hidradenitis suppurativa. They block tumor necrosis factor-alpha, a central pro-inflammatory cytokine.

IL-17 inhibitors (secukinumab, ixekizumab, brodalumab) target interleukin-17, a key driver of the psoriatic inflammatory cascade, and are used primarily for psoriasis and psoriatic arthritis.

IL-23 inhibitors (guselkumab, risankizumab, tildrakizumab) block interleukin-23 upstream of the Th17 pathway, also primarily for psoriasis, generally with less frequent dosing intervals than earlier classes.

IL-4/IL-13 inhibitors (dupilumab) target the Th2 pathway central to atopic dermatitis, and are also used in related conditions like chronic rhinosinusitis with nasal polyps and asthma.

JAK inhibitors (oral: upadacitinib, abrocitinib; topical: ruxolitinib cream) block Janus kinase signaling downstream of multiple cytokine receptors. Oral JAK inhibitors are used in moderate-to-severe atopic dermatitis and alopecia areata; topical ruxolitinib is used in atopic dermatitis and vitiligo.

General Monitoring Themes

Monitoring requirements vary by agent and should always follow the full prescribing information, but common themes across biologic and JAK therapy include:

  • Baseline tuberculosis and hepatitis B/C screening before starting most biologics
  • Attention to live vaccine timing relative to therapy initiation
  • Ongoing infection risk counseling, given the immunomodulatory mechanism shared across these classes
  • For oral JAK inhibitors specifically, awareness of boxed warning considerations around cardiovascular events, thrombosis, and malignancy risk carried in current labeling, which should be discussed with the prescriber and patient

Where Pharmacists Add Value

  • Injection technique counseling and troubleshooting for self-administered agents
  • Storage and handling guidance, since most biologics require refrigeration and careful cold-chain management
  • Supporting adherence, particularly around dosing interval changes during induction versus maintenance phases
  • Coordinating specialty pharmacy workflows, including prior authorization and appropriate use criteria

This is a mechanism-based educational overview, not prescribing guidance. Always consult full, current prescribing information and individualized clinical judgment before initiating or monitoring any biologic or targeted therapy.