• Author
    Armeen Barghi
  • Discovery PI

    Larissa N. Larsen, MD

  • Project Co-Author

    Ingyun Park BS, Crystal Luo BA, Shine Lim BS, Khoa B. Nguyen MD

  • Abstract Title

    Perioperative Management and Safety of Biologic and Targeted Immunomodulatory Therapies

  • Discovery AOC Petal or Dual Degree Program

    Basic, Clinical, & Translational Research

  • Abstract

    Keywords: Biologics; perioperative management

    Background: Biologic and targeted immunomodulatory therapies have transformed management of chronic inflammatory skin diseases including psoriasis, atopic dermatitis, hidradenitis suppurativa, alopecia areata, vitiligo, and prurigo nodularis. As use expands, dermatologists face complex perioperative decisions regarding continuation or interruption of therapy. Dermatology-specific data has limited evidence across current biologic classes — 24 agents spanning 11 drug classes — within a unified framework.

    Objective: To synthesize evidence on perioperative safety of biologic and targeted therapies in dermatology, emphasizing infection risk, wound healing, pharmacokinetics, and procedure-specific decision-making across drug classes and surgical risk strata.

    Methods: A review was conducted via PubMed, Embase, and Web of Science from inception through March 2026. Human studies were included: trials, observational studies, case series, registry analyses, and guidelines. Dermatology-specific populations were prioritized; rheumatology and gastroenterology cohorts were incorporated where dermatologic data were limited. Evidence was organized by drug mechanism and surgical risk using the ASA Physical Status Classification and Johns Hopkins Surgical Criteria.

    Results: Continuation of most biologic classes appears safe for low-risk procedures. IL-23, IL-12/23, and IL-4/IL-13 inhibitors demonstrated favorable perioperative infection profiles. IL-17 inhibitors showed increased mucocutaneous candidiasis without a serious infection signal. TNF-α inhibitors yielded mixed evidence; greater caution is warranted in higher-risk settings. JAK inhibitors carry regulatory warnings for serious infections and thromboembolism; rheumatology guidelines support withholding them three days before major surgery. A risk-stratification framework integrating ASA class, procedural category, pharmacokinetics, and disease flare risk is proposed.

    Conclusions: Perioperative biologic management in dermatology should shift from universal hold strategies toward individualized, mechanism-informed decision-making. Evidence is reassuring for low-risk procedures, but gaps remain for higher-risk operations, newer agents, and outcomes including wound healing, flap viability, and postoperative inflammatory recurrence. A future direction includes a prospective study. We offer a risk-stratified springboard to help guide perioperative decisions across current dermatologic drug classes.

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