Biologic therapies for dermatologic emergencies: A comprehensive review

Dermatologic emergencies are frequently characterized by pathologic immune activation, necessitating systemic immunosuppression to reduce morbidity and mortality. Conventional management has largely relied on supportive care, avoidance of triggers (ie, inciting drugs), and/or systemic immunosuppression. However, advancements in therapeutics have unlocked new treatment options that can be especially beneficial in the acute setting. Specifically, biologic medications are increasingly being used by inpatient dermatologists to target specific inflammatory pathways implicated in many acute dermatologic emergencies. Biologics offer a targeted alternative to systemic pan-immunosuppression, potentially minimizing systemic toxicity and improving outcomes. As more studies outline the immune mechanisms driving dermatologic emergencies, biologics are likely to have an increasing role in managing these conditions. This review offers practical guidance on the use of biologics in dermatologic emergencies, with a focus on drug reaction with eosinophilia and systemic symptoms, Stevens-Johnson syndrome/toxic epidermal necrolysis, pemphigus vulgaris, and generalized pustular psoriasis.