Systemic Therapy

When to consider systemic therapy in dermatology?

1. When topical drug delivery does not reach the target tissue.

e.g. onychomycosis (fungal nail infection)

2. When the disease has systemic sequelae and systemic treatment is needed.

e.g. cutaneous disease in systemic lupus erythematosus

e.g. bacterial skin infection in a patient with valvular heart disease

3. When topical therapy is ineffective and systemic therapy is more effective.

e.g. severe psoriasis

e.g. severe eczema

e.g. severe blistering disease

4. When the cutaneous disease is extensive making topical therapy inconvenient (provided that systemic therapy is not more toxic than topical treatment)

e.g. extensive fungal infection