B cell-targeted therapies in autoimmune skin disease: current advances and challenges

Autoimmune skin diseases (AISDs) constitute a group of skin disorders driven by B cell-mediated autoimmunity or dysregulation of other immune cell populations. AISD can be further divided into systemic autoimmune disease with skin involvement, such as systemic lupus erythematosus (SLE), and skin-specific autoimmune disease, such as pemphigus vulgaris (PV). Due to autoreactivity, B cells and autoantibody production play a pivotal role in B cell-driven AISDs. B cell-targeted therapies have become a major focus in research and clinical practice. Recent strategies targeting various B cell have shown promise, whereas several challenges remain in the clinical application. Patient heterogeneity results in variable therapeutic outcomes. Additionally, prolonged B cell suppression increases the risk of infections. Here, this review outlines the B cell-targeted therapeutic approaches in AISDs, explore the implications of their variable efficacy, and discuss future directions for development. We aim to provide broader perspectives for advancing targeted therapies in AISDs.