Perioperative management of modern dermatologic medications: an anesthesia-focused narrative review

Dermatologic diseases are highly prevalent worldwide and are managed with a broad pharmacologic spectrum ranging from topical agents to biologic therapies. Increasing life expectancy and chronic comorbidities have raised the surgical needs of these patients, creating a demand for careful perioperative management of wound healing, hemostasis, and infection risk, particularly in those receiving immunosuppressive or biologic agents. The existing literature, however, is scattered and largely extrapolated from dermatology, rheumatology, and orthopedic sources. This narrative review aims to provide an anesthesia-focused, evidence-based, drug-class-organized framework for the perioperative management of dermatologic medications in adults undergoing non-dermatologic surgery. Topical agents, systemic retinoids, conventional immunosuppressants, systemic corticosteroids, biologic agents, small molecules, and antimicrobial/antimalarial drugs are reviewed with respect to indications, pharmacokinetics, current guideline recommendations, and clinically relevant drug-anesthesia interactions. In general, most dermatologic medications, including topical agents, conventional immunosuppressants, and oral retinoids, can be safely continued perioperatively. However, biologic agents warrant half-life-based timing, Janus kinase inhibitors should be withheld at least three days before high-infection-risk surgery, and patients on chronic systemic corticosteroids require an individualized stress-dose approach. Specific interactions (isotretinoin-succinylcholine, dapsone-prilocaine, cyclosporine-CYP3A4 substrates, and hydroxychloroquine-QT-prolonging agents) require targeted attention. Because the evidence base is heterogeneous and largely observational, the recommendations are directional rather than definitive, and anesthesiologist-led prospective multicenter studies are needed.