Synopsis
Select targeted dermatology treatment through disease-specific NICE pathways, screen infection, vaccination, cardiovascular, malignancy and reproductive risk, match mechanism to comorbidity, and apply agent-specific response, laboratory and adverse-event monitoring.
- A marketing authorisation does not equal NHS eligibility: verify the current disease-specific NICE technology appraisal, severity threshold, previous-treatment requirement and local pathway before offering a drug.
- Biologics are antibodies or receptor proteins targeting cytokines or cells; small molecules enter cells and inhibit signalling enzymes such as JAK, TYK2 or PDE4 and often need more laboratory and interaction surveillance.
- Baseline review includes infection history, TB, hepatitis B and C, HIV by risk, vaccination, FBC, renal and liver function, pregnancy plans, malignancy, cardiovascular and thrombotic risk and disease-specific comorbidity.
Key red flags
Fever or systemic infection, shingles near the eye, persistent cough or weight loss, new neurological deficit, severe abdominal pain or bloody diarrhoea, chest pain, breathlessness, limb swelling, jaundice, marked cytopenia, anaphylaxis, pregnancy or new malignancy requires prompt treatment interruption and specialist assessment.
Hypotension, hypoxia, confusion, disseminated vesicles or rapidly spreading painful skin infection is an emergency even when inflammatory markers are blunted.
Investigation priorities
Demonstrate that the current NICE and local initiation criteria are met.
Management branches
Severe skin disease remains uncontrolled and targeted treatment is being considered.
- Confirm the live NICE indication, required severity and previous-treatment sequence and document an objective baseline outcome and goals important to the patient.
- Screen infection, vaccination, pregnancy, malignancy, cardiovascular, thrombotic, neurological, bowel and eye risks and map them against candidate mechanisms.