Protocols for the treatment of autoimmune diseases of the skin are complex and involve topical as well as systemic immunosuppressive interventions. Although most of these strategies offer an effective disease control, they are frequently associated with side effects. Therefore, there is a need to search for novel efficient therapies with a favourable safety profile. The recent improvement in our understanding of the underlying pathomechanisms and the major advances in biotechnology resulted in the development of several novel compounds and strategies for the treatment of autoimmune diseases such as specific therapeutic approaches targeting mechanisms responsible for immune dysfunction and break of tolerance. Current approaches focus on autoantigen recognition and autoantibody production, cytokine function and production, tolerance induction, and gene transcription (Feldmann and Steinman, 2005; Gottlieb, 2005).
Among several new drugs and cellular and gene-therapeutic approaches, the development of biologic agents (biologics) for the treatment of inflammatory and autoimmune diseases has gained major attention. A major progress in the treatment of autoimmune mediated diseases such as rheumatoid arthritis (RA), Crohn's disease, and psoriasis has been achieved. Biologics are agents with specific cellular targets such as cell surface molecules, (adhesion molecules and receptors) or intracellular molecules (transcription factors), which are designed to imitate or inhibit the actions of naturally occurring proteins. They are derived from living sources such as humans, animals, plants, and microorganisms and currently include: recombinant proteins (cytokines), monoclonal antibodies, fusion proteins, and toxin-labelled proteins. Strategies for biologic therapy are multiple and may consist of mediators that promote immune deviation, agents that inhibit the effects of proinflammatory cyto-kines, compounds that target pathogenic T-cells, and agents that disrupt the antigen presentation/ T-cell activation (Smolen and Steiner, 2003; Saripalli and Gaspari, 2005; Finucane and Archer, 2005; Kourbeti and Boumpas, 2005).
The present chapter reviews recent developments and available clinical experience with biological agents in the treatment of autoimmune diseases with a focus on their efficiency in skin lesions.
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