Principles of Systemic Therapy

Michael J. Tidman1, Catherine H. Smith


This chapter on systemic dermatological therapy aims to provide practising dermatologists with sufficient information about the most frequently used systemic medications to enable these to be used for treating skin disease to the maximum benefit and minimum detriment to their patients. The introduction covers general aspects of systemic therapy, including patient selection and education, risk reduction measures and the importance of good record keeping. Thereafter follows a detailed review of immunomodulatory and antimicrobial drugs, including antihistamines, antimalarial agents, azathioprine, ciclosporin, colchicine, dapsone, fumaric acid esters, glucocorticoids, hydroxycarbamide, methotrexate, mycophenolate mofetil, potassium iodide, protein therapies (biological drugs and intravenous immunoglobulin), retinoids, thalidomide, antibiotics, antifungal agents and antiviral drugs. The profile of each individual drug includes its pharmacological properties (formula and structure, pharmacodynamics, pharmacokinetics and, where relevant, pharmacogenetic aspects), potential adverse effects, contraindications, cautions, drug–drug interactions, pre‐treatment screening, dosage regimens, monitoring requirements and its range of licensed and off‐label dermatological usage.
Keywords drugs, therapeutics, pharmacology, systemic therapy, immunosuppressants, biologicals, antimicrobials, off‐label, drug toxicity, pharmacokinetics, pharmacodynamics


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