Cutaneous Side Effects of Biologic Therapy

Dr. Jeff Cohen from Yale discusses the cutaneous side effects of biologic therapy, particularly focusing on biologic monoclonal antibodies that have transformed treatments for various inflammatory skin conditions. He explains their mechanism of action, primarily involving the targeting of specific cytokines to regulate immune pathways, but notes the occurrence of paradoxical reactions. These reactions suggest the emergence or worsening of immune-mediated disorders secondary to biologic therapy, necessitating that dermatologists recognize and manage these conditions effectively. Dr. Cohen categorizes reactions into eczematous, psoriasiform, and other types, detailing their associations with different biologic classes like TNF-alpha inhibitors and IL-17 inhibitors. He provides insight into clinical presentation, incidence rates, and management strategies, emphasizing the importance of controlling underlying conditions while addressing paradoxical eruptions. The lecture also touches upon less common adverse effects, including lupus-like reactions and the significance of evaluating for neoplastic conditions, such as CTCL, in patients on biologics. Overall, understanding these side effects offers valuable insights into the immunological impacts of biologic therapies, enhancing treatment strategies and outcomes.