Emergency Dermatology: IMMUNOMODULATORS AND THE “BIOLOGICS” IN CUTANEOUS EMERGENCIES

BIOLOGIC AGENTS are proteins or antibodies engineered to target specific molecules. They are derived from the products of living organisms. In recent years, numerous drugs of this type have been added to the therapeutic armamentarium in various disciplines of medicine. In dermatology, psoriasis is so far the only entity for which various drugs of this type are approved. Two main groups of biologic agents are used in psoriasis: The first is tumor necrosis factor (TNF) blockers, and the second group consists of inhibitors of T lymphocytes or antigen-presenting cells. Drugs from the anti-TNF group, as well as additional biological agents from other specialties, have been used off-label in numerous skin diseases – some of them are dermatologic emergencies. No doubt, the increasing development and use of these drugs will also extend the number of possible indications in numerous skin diseases. This chapter reviews the current reports on these agents and their use in various dermatologic emergencies (Table 4.1). INFLIXIMAB Infliximab (Remicade; Centocor, Inc., Horsham, PA) is a chimeric immunoglobulin G1 (IgG1) monoclonal antibody containing human constant regions and murine variable regions. It binds and inhibits both soluble and transmembrane TNF-α and activates lysis of cells that express transmembrane TNF-α via antibody-dependent and complement-dependent cytotoxic mechanisms. Indications Indications for treating are rheumatoid arthritis (RA), psoriatic arthritis, ankylosing spondylitis, Crohn disease, ulcerative colitis, and moderate to severe plaque type psoriasis.