Systemic Therapy
In many dermatological, allergic, and venereal diseases, topical treatment is not sufficient in certain phases/stages and systemic therapy is required. The indication must always be established correctly, contraindications observed, and the expected benef
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Introduction
In many dermatological, allergic, and venereal diseases, topical treatment is not sufficient in certain phases/stages and systemic therapy is required. The indication must always be established correctly, contraindications observed, and the expected benefit weighed against possible adverse drug reactions (ADRs). In comparison with topical treatment, systemic treatments often have more intensive and faster effects and are easier to control. Disadvantages are the ADRs in other organ systems and interactions with other drugs, especially in elderly patients. Milder dermatoses limited to specific skin areas are treated more locally, but these can also, like recurrent herpes simplex type I or II, require systemic maintenance therapy with a virustatic agent. A severe psoriasis vulgaris with joint involvement is usually treated internally and externally combined. After the skin changes have healed, systemic therapy to suppress psoriatic arthritis can be continued with ciclosporin A, methotrexate (MTX), fumarates or biologics. The individual case history provides information as to whether relapsing diseases progress quickly and severely and therefore require the timely application of systemic treatment from the outset. Depending on individual circumstances, it is decided when, for example, a patient with impetiginized atopic eczema requires additional systemic antibiotics, a patient with tinea needs systemic antimycotics or a patient with severe allergic contact dermatitis must be treated with oral glucocorticoids at short notice. In S. Schreml (*) Department of Dermatology, University Hospital Regensburg, Regensburg, Germany e-mail: [email protected]; [email protected]
autoimmune diseases and severe allergic reactions, early systemic administration of immunosuppressive or immunomodulatory drugs is indicated immediately and can save lives. The systemic treatment of skin and venereal diseases has increased considerably in recent decades. It has become more differentiated owing to modern developments in pharmacology. In particular, for classes of substances (and their pharmacodynamics and adverse drug profiles) that also play a role in other medical disciplines, such as oncology, infectiology, hepatology, nephrology, or rheumatology, we refer the reader to textbooks on clinical pharmacology and toxicology. If the application of systemic treatment is predominantly within a certain disease group, this class of substance is discussed in the corresponding chapter, for example, systemic antimycotics in the chapter ▶ “Dermatomycoses”. With regard to comorbidities, drug interactions, risk factors, previous intolerances and patient compliance, collaboration with other physicians treating the patient is important. In this chapter, an overview of systemic dermatological therapy shall be given. In recent years, there has been an increase in new classes of agents such as biologics, small molecules, and targeted drugs in several fields of dermatology. Therefore, we pay particular attention to those age
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