ALTHOUGH PHYSICIANS from other specialties, like the population at large, still consider cutaneous maladies as being mainly aesthetic, skin deep, and insignificant, they are generally aware that treating these diseases often requires a variety of potent systemic drugs and not only topical treatments. These powerful medications may cause many adverse reactions, some of them severe, acute, or even life threatening.

“There are no really ‘safe’ biologically active drugs. There are only ‘safe’ physicians.” A “safe” physician must, first and foremost, be well informed about adverse reactions at the time of prescribing a drug, during the follow-up period, and especially when one of these rare catastrophes suddenly occurs. Because the diversity of severe adverse reactions to dermatologic therapies is almost endless, we focus on new drugs and the less known adverse effects.

TARGETED IMMUNE MODULATORS/BIOLOGICS

Targeted immune modulators (TIMs) – commonly referred to as biological response modifiers or simply “biologics” – are a relatively new category of medications used in the treatment of certain types of immunologic and inflammatory diseases, including dermatologic diseases, most notably psoriasis.

Overall, TIMs appear to have a good tolerability profile, although some rare but acute serious adverse events, such as infections, hematologic events, neurologic events, infusion reactions, congestive heart failure, nephrotic syndrome, and others, are of concern. The following sections describe adverse events associated with TIMs.