Clinical implementation of pharmacogenetics in inflammatory skin diseases: current evidence and future directions

BACKGROUND: Pharmacogenetic biomarkers have been proposed to personalize systemic therapy in inflammatory skin diseases by improving efficacy, reducing toxicity, and optimizing long-term treatment outcomes. However, their clinical implementation in dermatology remains limited. METHODS: A structured literature review with narrative synthesis was performed using PubMed/MEDLINE (January 2010-April 2026) to evaluate pharmacogenetic evidence for systemic therapies used in psoriasis, atopic dermatitis, acne vulgaris, and rosacea. Evidence from pharmacogenetic studies, meta-analyses, and guideline recommendations was assessed. RESULTS: Pharmacogenetic guidelines were identified for cyclosporine A, methotrexate and carvedilol. The strongest evidence was observed for methotrexate, with variants in genes involved in folate metabolism and drug transport associated with treatment response and toxicity. Emerging evidence was identified for cyclosporine A, glucocorticoids, adalimumab and selected targeted therapies. In contrast, current data do not support a clinically relevant pharmacogenetic impact for secukinumab or isotretinoin. For many therapies, evidence remains exploratory, inconsistent or entirely lacking. CONCLUSION: Pharmacogenetics in dermatology remains largely investigational. Although several promising biomarkers have been identified, robust validation and harmonized clinical endpoints are required before genotype-guided treatment strategies can be implemented in routine dermatologic practice.