Treatment of immune-mediated skin diseases: future perspectives

In recent years there has been an enormous increase in the understanding of the pathogenesis of immune mediated skin diseases which has led to the development and introduction of new therapeutic regimes. Accordingly, non-specific immunomodulating drugs such as cyclosporin A (CyA), rapamycin, leflunomide, mycophenolat mofetil, tacrolimus, pimecrolimus (ASM981) a.o. proved to be beneficial for a variety of skin diseases. Immunomodulators such as tacrolimus, ASM981 and imiquimod also have been developed for topical application. Specific immunomodulating strategies involve humanized antibodies directed against cytokines or cell surface molecules, receptor antagonists, fusion proteins targeting cytokines or receptors and transcription factor inhibitors. Another interesting approach is to target the appropriate T cell-receptor on autoreactive T cells. Transfection with cytokine genes may represent a useful approach to generate immune deviation and, thereby, treat immune mediated diseases. The value of different vaccination strategies are currently investigated. The first promising results have been obtained by targeting the function of antigen-presenting cells such as dendritic cells (DC). Although, the rapid development of research in immune-mediated diseases has led to the development of several new and more effective therapeutic strategies, in most cases cure is still not possible until the genetics of these diseases are revealed which ultimately may result in gene therapy.