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Unmet Medical Needs in Chronic, Non-communicable Inflammatory Skin Diseases
Open accessAbstract
An estimated 20-25% of the population is affected by chronic, non-communicable inflammatory skin diseases. Chronic skin inflammation has many causes. Among the most frequent chronic inflammatory skin diseases are atopic dermatitis, psoriasis, urticaria, lichen planus, and hidradenitis suppurativa, driven by a complex interplay of genetics and environmental factors. Autoimmunity is another important cause of chronic skin inflammation. The autoimmune response may be mainly T cell driven, such as in alopecia areata or vitiligo, or B cell driven in chronic spontaneous urticaria, pemphigus and pemphigoid diseases. Rare causes of chronic skin inflammation are autoinflammatory diseases, or rheumatic diseases, such as cutaneous lupus erythematosus or dermatomyositis. Whilst we have seen a significant improvement in diagnosis and treatment, several challenges remain. Especially for rarer causes of chronic skin inflammation, early diagnosis is often missed because of low awareness and lack of diagnostics. Systemic immunosuppression is the treatment of choice for almost all of these diseases. Adverse events due to immunosuppression, insufficient therapeutic responses and relapses remain a challenge. For atopic dermatitis and psoriasis, a broad spectrum of innovative treatments has been developed. However, treatment responses cannot be predicted so far. Hence, development of (bio)markers allowing selection of specific medications for individual patients is needed. Given the encouraging developments during the past years, we envision that many of these challenges in the diagnosis and treatment of chronic inflammatory skin diseases will be thoroughly addressed in the future.
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Hundt, J. E., Hoffmann, M. H., Amber, K. T., & Ludwig, R. J. (2023) · Frontiers in Immunology · doi:10.3389/fimmu.2023.1159396 · Cited by 7
“This would have a significant impact on affected individuals, as well as the healthcare system because the incidence of autoimmune and non-communicable inflammatory diseases is rising and there are still many unmet medical needs in the care of patients with these diagnoses (12, 13).”
BackgroundArtificial intelligence–enabled precision medicine for inflammatory skin diseases
Tang, A. S., Wei, M. L., Haemel, A., La, C., Sirota, M., & Lee, E. Y. (2026) · Journal of Investigative Dermatology · doi:10.1016/j.jid.2025.10.596 · Cited by 10
Zirpel, H., Ludwig, R. J., Olbrich, H., Kridin, K., Ständer, S., & Thaçi, D. (2024) · Journal of Dermatological Treatment · doi:10.1080/09546634.2024.2421429 · Cited by 7
“The chronic-recurrent inflammatory nature of AD with its comorbidities and potential treatment-related adverse events due to commonly used conventional treatment options poses a significant burden on affected patients (5).”
Pemphigoid disease model systems for clinical translation
Tigges, M., Dräger, S., Piccini, I., Bieber, K., Vorobyev, A., Edelkamp, J., Bertolini, M., & Ludwig, R. J. (2025) · Frontiers in Immunology · doi:10.3389/fimmu.2025.1537428 · Cited by 6
A translational approach to improve therapeutics in atopic dermatitis and beyond
Liu, D., Patel, D., Lau, M., Largen, J., Hu, B., He, H., & Guttman‐Yassky, E. (2025) · The Journal of Immunology · doi:10.1093/jimmun/vkaf049 · Cited by 7
Raap, U., Limberg, M. M., Kridin, K., & Ludwig, R. J. (2023) · Biomolecules · doi:10.3390/biom13030485 · Cited by 6
“This is mainly due to the limited and partially insufficient treatment options, as well as a significant, often treatment‐associated, (co)‐morbidity [7,8].”
BackgroundType XVII Collagen–Specific CD4+ T Cells Induce Bullous Pemphigoid by Producing IL-5
Yoshimoto, N., Muramatsu, K., Ito, T., Zheng, M., Izumi, K., Natsuga, K., Iwata, H., Hasegawa, Y., & Ujiie, H. (2024) · Journal of Investigative Dermatology · doi:10.1016/j.jid.2024.08.026 · Cited by 6
Güldorum, Y., Danısık, M. N., Zia, M. K., Aldemir, N., Ulağ, S., Bicer, L., Kaya, E., Şahin, A., Tinaz, G. B., & Gündüz, O. (2025) · Emergent Materials · doi:10.1007/s42247-025-01043-6 · Cited by 6
“Chronic, non-infectious inflammatory skin diseases, such as atopic dermatitis, psoriasis, urticaria, lichen planus, and hidrad-enitis suppurativa, affect 20–25% of the population [ 3, 4].”
Unmet needs in treating itch: reaching beyond eczema
Brooks, S. G., & Yosipovitch, G. (2024) · Journal of Dermatological Treatment · doi:10.1080/09546634.2024.2351487 · Cited by 5
“As such, broad-spectrum immunosuppressants, such as systemic corticosteroids, cyclosporine, methotrexate, and azathioprine are often used as a default treatment option for those conditions thought to have an immune component (7).”
InfluentialDigkas, T., Tefas, L. R., Porfire, A. S., Tomuță, I., & Beer, T. D. (2025) · International Journal of Pharmaceutics · doi:10.1016/j.ijpharm.2025.125964 · Cited by 6
Liakou, A. Ι., Routsi, E., Plisioti, K., Tziona, E., Koumaki, D., Kalamata, M., Bompou, E., Sokou, R., Ιωάννου, Π., Bonovas, S., et al. (2025) · Microorganisms · doi:10.3390/microorganisms13092129 · Cited by 5
Gürtler, A.-L., Maltschik, A. M., Yildiz, S. M. G., Vangelofski, K., Gade, L., Grohganz, H., Rades, T., & Heinz, A. (2024) · European Journal of Pharmaceutics and Biopharmaceutics · doi:10.1016/j.ejpb.2024.114423 · Cited by 5
Kim, G. H., Lee, S. Y., Oh, S., Jang, J.-W., Lee, J. H., Kim, H., Son, K. H., & Byun, K. (2024) · International Journal of Molecular Sciences · doi:10.3390/ijms252312522 · Cited by 6
Cutaneous Manifestations in Patients with Dermatomyositis, Are They Only Skin Deep?
McKee, S., Xenakis, J. J., Makin, H., Marshall, C., Winnette, R., Aggarwal, R., & Knight, S. (2024) · Dermatology and Therapy · doi:10.1007/s13555-024-01266-1 · Cited by 5
“It has been reported that the amount of cutaneous involvement that a patient has correlates directly with the impact on their QoL [4, 5].”
BackgroundGürtler, A.-L., Lang, J. C., Czyrski, G. S., Sirois, J. P., Melican, K., Rades, T., & Heinz, A. (2024) · Biomaterials Advances · doi:10.1016/j.bioadv.2024.214068 · Cited by 5
Cao, X., He, R., Xu, D., & Zhao, Y. (2025) · Bioactive Materials · doi:10.1016/j.bioactmat.2025.09.040 · Cited by 4
“[185 – 188].”
Systematizing PDE4 Inhibition in Psoriasis Treatment: Roflumilast Leads the Way
Ravindran, R., Muralidharan, P., & Govindarajan, A. (2025) · Journal of Young Pharmacists · doi:10.5530/jyp.20251506 · Cited by 6
Frau, F., Loustalot, P., Törnqvist, M., Temam, N., Cupe, J., Montmerle, M., & Augé, F. (2025) · Scientific Reports · doi:10.1038/s41598-024-78794-5 · Cited by 4
“Despite that, AD affects up to 30% of the paediatric population and 2–10% of adults 8 , there are still many unmet medical needs.”
Kim, S., Kim, N. H., Khaleel, Z. H., Sa, D. H., Choi, D., Ga, S., Kim, C. G., Jang, J., Kim, K., Kim, Y. J., et al. (2023) · Advanced Therapeutics · doi:10.1002/adtp.202300353 · Cited by 4
Predatory journals in dermatology: a bibliometric review
Shamsi, A., Wang, T., Raju, N. V., Ghamgosar, A., Davani, G. M., & Mansourzadeh, M. J. (2024) · Online Information Review · doi:10.1108/oir-04-2023-0161 · Cited by 4
Improving systemic therapy selection for inflammatory skin diseases: A clinical need survey
Brownstone, N. D., Farberg, A. S., Litchman, G. H., Quick, A. P., Siegel, J. J., Hurton, L. V., Goldberg, M. S., & Lio, P. (2024) · JAAD International · doi:10.1016/j.jdin.2024.03.019 · Cited by 4
Most Frequent Comorbidities in Patients With Lichen Planopilaris: A Cross-Sectional Study
Nejad, K. G., Ghadarjani, R., Eftekhari, H., & Sheykholeslami, S. (2023) · International Journal of Dermatology and Venereology · doi:10.1097/jd9.0000000000000306 · Cited by 4
“15 Brankov et al .”
Kola-Mustapha, A. T., Abdulrahman, M. O., & Ishola, I. O. (2023) · Scientific African · doi:10.1016/j.sciaf.2023.e01942 · Cited by 4
Hair Transplantation for Lichen Planopilaris: A Case Series of Five Patients
Osipowicz, K., Turkowski, P., Kowaléwski, C., Pach, J., Regulski, P. A., & Woźniak, K. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14176199 · Cited by 3
“…medical therapy can only slow down the progression of the disease, leaving patients with noticeable hair loss, which negatively affects their psychological well-being [3]; therefore, surgical treatment of the esthetic consequences of this condition remains an important and unmet medical need [4].”
Advances in Bioprinting to Model Immune‐Mediated Skin Diseases
Ulloa‐Fernández, A., Marković, M., Fernández‐Pérez, J., Stary, G., & Ovsianikov, A. (2025) · Advanced Healthcare Materials · doi:10.1002/adhm.202503806 · Cited by 3
Salman, S., Raccah, S., Rousseaud, A., Declercq, L., & Kerdine‐Römer, S. (2024) · Journal of Photochemistry and Photobiology · doi:10.1016/j.jpap.2024.100227 · Cited by 3
Ferček, I., Ozretić, P., Andrašević, A. T., Trajanoski, S., Ćesić, D., Jelić, M., Geber, G., Žaja, O., Paić, J., Lugović‐Mihić, L., et al. (2024) · Life · doi:10.3390/life14091091 · Cited by 3
“Using three addi-Life tional indices, we observed a trend toward reduced biodiversity in patients with atopic dermatitis, seborrheic dermatitis, and rosacea.”
MethodResultNeha, N., Joshi, R., Bhave, A., Bhagat, S. V., Veligandla, K. C., Rathod, R., & Kotak, B. (2023) · Cureus · doi:10.7759/cureus.45032 · Cited by 3
“Currently, the clinical significance of moisturizers is appropriately documented furthermore positioning plant-based natural moisturizers as a preferable first-line treatment [9,10].”
BackgroundThe epidemiology of inflammatory skin disease in older adults
West, D., Roberts, A. M., STROEBEL, B. M., & Abuabara, K. (2024) · JAAD International · doi:10.1016/j.jdin.2024.09.013 · Cited by 3
Cugno, G., Schneider‐Burrus, S., Kokolakis, G., Wilsmann‐Theis, D., Assaf, K., Mößner, R., Kromer, C., Bechara, F. G., Rached, N. A., Peitsch, W. K., et al. (2025) · Frontiers in Medicine · doi:10.3389/fmed.2025.1626345 · Cited by 2
Jiang, Q. L., Tang, Y.-X., & Zhou, G. (2025) · International Immunopharmacology · doi:10.1016/j.intimp.2025.115457 · Cited by 2
Truong, K., Luu, W., & Fernández‐Peñas, P. (2025) · Australasian Journal of Dermatology · doi:10.1111/ajd.14616 · Cited by 2
Gazerani, P. (2023) · Neuroglia · doi:10.3390/neuroglia4010002 · Cited by 3
“Cutaneous conditions that accompany itch include but are not limited to psoriasis, atopic dermatitis, and lichen planus [9].”
Background
Metadata
- Authors
- Ujiie, H., Rosmarin, D., Schön, M. P., Ständer, S., Boch, K., Metz, M., Maurer, M., Thaci, D., Schmidt, E., Cole, C., Amber, K. T., Didona, D., Hertl, M., Recke, A., Graßhoff, H., Hackel, A., Schumann, A., Riemekasten, G., Bieber, K., Sprow, G., Dan, J., Zillikens, D., Sezin, T., Christiano, A. M., Wolk, K., Sabat, R., Kridin, K., Werth, V. P., & Ludwig, R. J.
- Affiliations
- Hokkaido University (JP)
- Tufts Medical Center (US)
- Universitätsmedizin Göttingen (DE)
- University Hospital Münster (DE)
- University of Lübeck (DE)
- Humboldt-Universität zu Berlin (DE)
- Rush University Medical Center (US)
- Philipps University of Marburg (DE)
- Philadelphia VA Medical Center (US)
- Columbia University Irving Medical Center (US)
- Charité – Universitätsmedizin Berlin (DE)
- Bar-Ilan University (IL)
- Corresponding author
- Ludwig, Ralf J.
- ORCID
- Ujiie, Hideyuki
- Rosmarin, David
- Schön, Michael P.
- Ständer, Sonja
- Boch, Katharina
- Metz, Martin
- Maurer, Marcus
- Schmidt, Enno
- Cole, Connor
- Amber, Kyle T.
- Didona, Dario
- Hertl, Michael
- Recke, Andreas
- Graßhoff, Hanna
- Hackel, Alexander
- Riemekasten, Gabriela
- Bieber, Katja
- Dan, Joshua
- Zillikens, Detlef
- Sezin, Tanya
- Christiano, Angela M.
- Wolk, Kerstin
- Sabat, Robert
- Kridin, Khalaf
- Werth, Victoria P.
- Ludwig, Ralf J.
- Venue
- Frontiers in Medicine
- Publisher
- Frontiers Media SA
- Published
- 2022-06-09
- Volume
- 9
- Pages
- 875492-875492
- ISSN
- 2296-858X (ISSN-L)
- PMC
- PMC9218547
- OpenAlex
- W4285740668
- Cited by
- 158
- References
- 389
- Citations by year
- 2026: 20 · 2025: 40 · 2024: 49 · 2023: 37 · 2022: 12
- FWCI
- 6.14
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Medicine (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Fraunhofer-Publica (Fraunhofer-Gesellschaft) (submittedVersion)
- GoeScholar The Publication Server of the Georg-August-Universität Göttingen (Georg-August-Universität Göttingen) (submittedVersion, cc-by)
- Funders
- Deutsche Forschungsgemeinschaft (EXC 2167, FOR 2497, FOR 2690, RI/1056-11,, SFB 1526)
- National Institutes of Health (R01AR071653, R01AR076766)
- Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung (CRSII5_202301/1)
- Topics
- Health Sciences › Medicine › Dermatology › Dermatology and Skin Diseases
- Life Sciences › Immunology and Microbiology › Immunology › Psoriasis: Treatment and Pathogenesis
- Health Sciences › Medicine › Rheumatology › Systemic Sclerosis and Related Diseases
- Keywords
- chronic inflammatory skin disease, unmet medical needs, atopic dermatitis, psoriasis, urticaria, lichen planus, hidradenitis suppurativa, alopecia areata, vitiligo, pemphigus, pemphigoid diseases, cutaneous lupus erythematosus, dermatomyositis, autoinflammatory disease, systemic immunosuppression, biomarkers, treatment response prediction, early diagnosis
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