Drug Resistance in Skin Diseases

Skin is the largest organ of the body and the biggest barrier against pathogens. Skin diseases have become one of the most challenging medical problems in clinical practices, and a tremendous burden to the healthcare system in terms of cost and consumption of institutional resources. The emergence of drug resistance is a threat and concern in various clinical implications of skin diseases, particularly those that have secondary intervention such as chemotherapy, as the main treatment option. Multidrug-resistant organisms include bacteria and other microorganisms that have grown resistance to antimicrobial drugs. Resistance to antimicrobial drugs reduces the effectiveness of treatment and increases the severity of dermatologic diseases. Methicillin-resistant Staphylococcus aureus (MRSA), Vancomycin-Resistant Enterococci (VRE), and multidrug-resistant gram-negative rods (MDR GNR) bacteria are the common multidrug-resistant organisms (MDROs). Skin cancers have poor prognosis and treatment options, due to resistance to conventional chemotherapies. The exact mechanisms of resistance in skin cancers are not known, however most tumors likely resist through reduced apoptosis. Many molecular pathways, enzymes and genes are implicated in the process of reduced “apoptosis induction”. Similarly, acyclovir (ACV) and related analogues are successful drugs against HSV infections, however the emergence of drug resistance to ACV has become an obstacle in the treatment of HSV infections, especially in patients with low immunity. In this chapter, we have attempted to discuss major skin diseases and relevant factors that contribute to drug resistance in many dermatologic conditions.