Medicinal products used in dermatology: Classification and mechanisms of action

Abstract

Medicinal products used to treat dermatology diseases can be applied topically or systemically, which offers the possibility of various therapeutic modifications. However, skin changes are numerous and also very common in the general population. Many of them are difficult to manage satisfactorily with the existing means, and there is a need to develop novel drugs. Nevertheless, few novel drugs indicated for diseases treated primarily by dermatologists were introduced in recent decades. There are four difficulties to be overcome: the lack of a huge economic potential of these drugs, their hard-to-assess benefit-to-risk relationship, limitations of inadequate surrogate end points as well as incompleteness of knowledge of the pathophysiological substrates of skin diseases. The current drugs have various and sometimes only partly understood mechanisms of action. It is a common situation that there are no officially indicated medicines for a disease, resulting in widespread unlicensed and off-label administration of drugs. There are many unmet therapeutic needs and one of recent breakthroughs in the field was related to the introduction of biologic drugs, otherwise originally developed mainly for internal diseases.

Lekoviti proizvodi koji se koriste u tretmanu dermatoloških bolesti mogu da se primenjuju topikalno (lokalno) ili sistemski, što omogućuje različite modifikacije u terapiji. Međutim, kožne promene su raznovrsne i vrlo česte u opštoj populaciji. Mnoge od njih je teško kontrolisati na zadovoljavajući način sa postojećim sredstvima i postoji potreba za razvojem novih lekova. Uprkos potrebama, poslednjih decenija je uvedeno malo novih lekova primarno indikovanih za primenu od strane dermatologa. Postoje četiri poteškoće koje je potrebno prevazići: izostanak velikog ekonomskog potencijala ovih lekova, teškoće u proceni odnosa koristi i rizika, ograničenja usled neadekvatnosti surogatnih parametara procena i nekompletnost poznavanja patofiziološkog supstrata kožnih bolesti. Postojeći lekovi imaju različite i često samo parcijalno upoznate mehanizme dejstva. Uobičajena je situacija da za pojedina stanja nema zvanično indikovanih lekova, što dovodi do široke primene lekova van i bez upotrebne licence. Brojne su neispunjene terapijske potrebe i jedan od skorašnjih pomaka u oblasti odnosio se na uvođenje bioloških lekova, koji su prvobitno razvijani prvenstveno za lečenje bolesti unutrašnjih organa.