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Biologics and JAK inhibitors in dermatology
Biologics block a specific cytokine or receptor in the inflammatory pathway — TNF, IL-17 or IL-23 in psoriasis, IL-4/IL-13 in atopic dermatitis, IgE in urticaria — so the choice depends on the disease, comorbidities and safety.
Why it matters in the exam
The exam shows a patient with moderate to severe psoriasis who failed topical treatment and phototherapy, and asks which biologic suits a given comorbidity: inflammatory bowel disease (avoid IL-17 inhibitors, which may worsen it), advanced heart failure or demyelinating disease (avoid TNF inhibitors), pregnancy (certolizumab, which barely crosses the placenta), or psoriatic arthritis (TNF or IL-17). Also asked are pre-treatment tests — screening for latent tuberculosis (IGRA), hepatitis B and C and HIV — the ban on live vaccines, and typical side effects: candida with IL-17 inhibitors, conjunctivitis with dupilumab, and paradoxical psoriasis with TNF inhibitors. Oral JAK inhibitors (upadacitinib, abrocitinib, baricitinib) carry a warning for cardiac events, thrombosis, malignancy and infection, mainly over age 65 or with risk factors. Remember that IL-23 inhibitors are given infrequently (every 8–12 weeks) and are often chosen for convenience and safety. Dupilumab is the first systemic treatment for severe atopic dermatitis in children and adults.
Key points
- Biologics block a specific cytokine or receptor, and the choice depends on the disease, comorbidities and safety.
- In psoriasis TNF, IL-17, IL-23 and IL-12/23 inhibitors are used, and in atopic dermatitis IL-4/IL-13 inhibitors.
- Before treatment, screen for tuberculosis, hepatitis B and C and HIV, and avoid live vaccines.
- IL-17 inhibitors cause candida and may worsen bowel disease, and TNF inhibitors are contraindicated in advanced heart failure and demyelination.
- Oral JAK inhibitors are effective but carry a warning for cardiac events, thrombosis, malignancy and infection.
Summary table
| Class | Drugs | Main indications | Safety and notes |
|---|---|---|---|
| TNF inhibitors | Adalimumab, etanercept, infliximab, certolizumab | Psoriasis, psoriatic arthritis, HS (adalimumab) | Tuberculosis, heart failure, demyelination, paradoxical psoriasis; certolizumab in pregnancy |
| IL-17 inhibitors | Secukinumab, ixekizumab, bimekizumab | Psoriasis, psoriatic arthritis, HS | Candida; avoid in inflammatory bowel disease |
| IL-23 and IL-12/23 inhibitors | Guselkumab, risankizumab, tildrakizumab; ustekinumab | Psoriasis; IBD (ustekinumab, risankizumab) | Good safety, dosing every 8–12 weeks |
| IL-4/IL-13 and IL-31 inhibitors | Dupilumab, tralokinumab, lebrikizumab; nemolizumab | Atopic dermatitis, prurigo nodularis | Conjunctivitis, eosinophilia; no routine laboratory monitoring needed |
| Anti-IgE and JAK inhibitors | Omalizumab; upadacitinib, abrocitinib, baricitinib, ritlecitinib | Chronic urticaria; atopic dermatitis, alopecia areata | JAK: warning for cardiac events, thrombosis, malignancy and infection |
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Sources
- Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with biologics, 2019 — Biologic classes and screening
- European S3 guideline on the systemic treatment of psoriasis vulgaris (EuroGuiDerm), 2023 — Choice of biologic
- AAD guidelines of care for the management of atopic dermatitis with phototherapy and systemic therapies, 2023 — Dupilumab, tralokinumab and JAK inhibitors
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.