Yuan Michelle, Lee Jinwoo, Taylor Mark, Cho Raymond J, Cheng Jeffrey B
Department of Dermatology, University of California, San Francisco, 1701 Divisadero Street, 3rd Floor, San Francisco, CA, 94115, USA.
Dermatology Service, San Francisco Veterans Administration Health Care System, San Francisco, CA, USA.
Am J Clin Dermatol. 2025 Aug 17. doi: 10.1007/s40257-025-00963-7.
The growing availability of targeted immunomodulatory therapies has transformed the treatment landscape for chronic inflammatory skin diseases. However, treatment selection remains largely empirical, often guided more by trial-and-error and insurance mandates than by an individual patient's underlying disease biology. This disconnect between therapeutic strategy and the need to address and calibrate for patient molecular heterogeneity undermines clinical outcomes and contributes to inefficiency in care delivery. Precision medicine offers a solution by tailoring diagnosis and treatment to the molecular and cellular features of each patient's skin disease. In this Current Opinion, we outline key clinical contexts where precision approaches can be transformative: diagnostic ambiguity, selecting treatments for an established diagnosis, and selecting treatments without a defined diagnosis or disease mechanism. We highlight advances in precision techniques such as single-cell RNA sequencing and spatial transcriptomics that enable more refined skin disease classification and accurate prediction of drug response. Although several challenges remain before these techniques can be widely adopted, such as limited biomarker validation, high costs, and a lack of breadth in research cohorts, we argue that their potential benefits, for patients, clinicians, and the broader field of dermatologic care, substantially outweigh the associated costs. We advocate for expanded funding, population-based research, and scalable diagnostics to successfully integrate precision medicine into dermatology. By combining molecular phenotyping with traditional clinicopathologic diagnosis, precision medicine can reduce therapeutic inefficiency, improve patient outcomes, and redefine care paradigms in chronic inflammatory skin disease.
靶向免疫调节疗法日益普及，改变了慢性炎症性皮肤病的治疗格局。然而，治疗选择在很大程度上仍然是经验性的，更多地受反复试验和保险规定的指导，而非患者个体潜在的疾病生物学特性。治疗策略与应对和校准患者分子异质性需求之间的这种脱节，损害了临床疗效，并导致医疗服务效率低下。精准医学通过根据每位患者皮肤病的分子和细胞特征量身定制诊断和治疗方案，提供了一种解决方案。在本述评中，我们概述了精准方法可能具有变革性的关键临床背景：诊断不明确、针对已确诊疾病选择治疗方法，以及在未明确诊断或疾病机制的情况下选择治疗方法。我们强调了精准技术的进展，如单细胞RNA测序和空间转录组学，这些技术能够实现更精细的皮肤病分类和药物反应的准确预测。尽管在这些技术能够被广泛采用之前仍存在一些挑战，如生物标志物验证有限、成本高昂以及研究队列缺乏广度，但我们认为，它们对患者、临床医生和更广泛的皮肤病护理领域的潜在益处，大大超过了相关成本。我们主张扩大资金投入、开展基于人群的研究以及开发可扩展的诊断方法，以成功地将精准医学融入皮肤病学。通过将分子表型分析与传统的临床病理诊断相结合，精准医学可以减少治疗的低效率，改善患者预后，并重新定义慢性炎症性皮肤病的护理模式。
