Systemic immunosuppressants and biologics in dermatology
When skin disease needs systemic therapy, the conventional drugs and targeted agents by condition, how to read a pre-treatment screen and monitoring bloods, what to do when results move, and the infection, cancer, vaccine, pregnancy and PBS implications.
Tier 2Medical sciences concept
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Systemic therapy is for skin disease that is extensive, at high-impact sites, disabling, or uncontrolled by adequate topical treatment and phototherapy, or for diseases that are systemic from the start (pemphigus, DRESS, severe vasculitis).
- Conventional drugs (methotrexate, ciclosporin, azathioprine, mycophenolate, acitretin, dapsone, prednisolone) are cheap and familiar but need blood monitoring.
- Targeted drugs (biologics, JAK, TYK2 and PDE4 inhibitors) are more effective for psoriasis and eczema but PBS access has rules.
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Sources
- Therapeutic Guidelines: Dermatology (systemic therapy topics)AU/NZTherapeutic Guidelines Limited (eTG complete), Version 5, 2022 (no newer edition found, November 2026)
- PBS Schedule: biological medicines for severe chronic plaque psoriasis, severe atopic dermatitis and moderate to severe hidradenitis suppurativaAU/NZAustralian Government Department of Health, Disability and Ageing (PBS), Schedule checked November 2026
- Hidradenitis suppurativa: Written Authority Required drugs, patient eligibility (adalimumab, secukinumab, bimekizumab)AU/NZServices Australia, Checked November 2026 (bimekizumab listed December 2025)
- Australian Immunisation Handbook: Zoster (herpes zoster) and vaccination for people who are immunocompromisedAU/NZAustralian Technical Advisory Group on Immunisation (ATAGI), Zoster chapter updated January 2026
- Foley P et al. Australian consensus: treatment goals for moderate to severe psoriasis in the era of targeted therapies. Adult patients. Australas J Dermatol 2023;64:476-87AU/NZAustralasian College of Dermatologists, 2023
- O'Donovan P et al. Azathioprine and UVA light generate mutagenic oxidative DNA damage. Science 2005;309:1871-4Science, 2005
- Davis DMR et al. Guidelines of care for the management of atopic dermatitis in adults with phototherapy and systemic therapies. J Am Acad Dermatol 2024;90:e43-56American Academy of Dermatology, 2023 guideline (published 2024), focused update 2025
- Last updated
- 14 November 2026
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