Advancing Precision Medicine in Inflammatory Skin Disease

The growing availability of targeted immunomodulatory therapies has transformed the treatment landscape for chronic inflammatory skin diseases. However, treatment selection remains largely empirical, often guided more by trial-and-error and insurance mandates than by an individual patient's underlying disease biology. This disconnect between therapeutic strategy and the need to address and calibrate for patient molecular heterogeneity undermines clinical outcomes and contributes to inefficiency in care delivery. Precision medicine offers a solution by tailoring diagnosis and treatment to the molecular and cellular features of each patient's skin disease. In this Current Opinion, we outline key clinical contexts where precision approaches can be transformative: diagnostic ambiguity, selecting treatments for an established diagnosis, and selecting treatments without a defined diagnosis or disease mechanism. We highlight advances in precision techniques such as single-cell RNA sequencing and spatial transcriptomics that enable more refined skin disease classification and accurate prediction of drug response. Although several challenges remain before these techniques can be widely adopted, such as limited biomarker validation, high costs, and a lack of breadth in research cohorts, we argue that their potential benefits, for patients, clinicians, and the broader field of dermatologic care, substantially outweigh the associated costs. We advocate for expanded funding, population-based research, and scalable diagnostics to successfully integrate precision medicine into dermatology. By combining molecular phenotyping with traditional clinicopathologic diagnosis, precision medicine can reduce therapeutic inefficiency, improve patient outcomes, and redefine care paradigms in chronic inflammatory skin disease.