One size does NOT fit all - The future of derma drugs is personal

We live in an era of personalization. This increasing and unrelenting tailoring experience has begun to slowly take over our lives, from a simple online purchase to a lifesaving treatment plan. Just like companies personalize their campaigns, serving as a helpful lens to ensure the best services, the health care system is using genetics to tailor treatment plans for each individual, by a relatively new method: Personalized Medicine. The study of genes in the past century has had a great impact on people’s perception of ancestry, nutrition, diagnosis and drugs. So, if you are asking yourself, who you should blame for that major side effect of that drug you have been taking for a while? Well, the answer is probably your parents.



Personalized medicine is a novel, yet promising field of medicine, defined as “an approach to both preventive care and to drug therapy based on the individual’s genetic information.” (1) From the genesis of treating to the post-genomic era, patients have always been labeled as their condition. What personalized medicine offers is the possibility of analyzing and treating patients by their genetic portfolio, which can help doctors understand the underlying cause of the disease. (2) In other words, the mantra of personalized medicine is to provide “the right dose, of the right drug, for the right indication, for the right patient, at the right time. (1)


However, the success of personalized medicine relies on the integration of multiple levels of information. In the base of its pyramid lies the study of the human genome; however, scientists are now able to gather data from all metabolic products, including a detailed protein profiling. This is providing a sensitive snapshot of the body’s physiology, acting also as a guided discovery of biomarkers. On the other hand, the influence of the environment, aka the exposome, is also helping scientists gather profound information. Whereas microbiome studies, which include the discovery of all microorganisms living in our body, is revolutionizing treatments, especially of dermatological diseases, all in all allowing the closure of the gap between diagnostics and treatment options. (1)


In the field of dermatology, mostly regarded as a purely visual subject, with therapies based solely on clinical examination, molecular procedures were only newly integrated into everyday clinical practice. Oncology is certainly paving the way. As part, melanoma management based on specific markers and mutations has undoubtedly been a breakthrough in the field, causing a dramatic change in patient outcomes. (3) The majority of melanomas have mutations associated with the mitogen-activated protein kinase (MAPK) pathway, an important signal transduction pathway. Scientifically speaking, it seems like the most complicated process, right? Try imagining it like a series of dominos, which start to fall the moment the BRAF kinase mutation happens. This occurs in ~40–60% of cases, which has made molecular testing for BRAF mutations a standard for determining the course of therapy. (4)

On the other hand, chronic inflammatory skin diseases, like psoriasis, atopic dermatitis, and also alopecia and vitiligo, are currently unmet medical needs. (1) The treatment of inflammatory skin diseases has bounced from glucocorticoids and topical treatments to effective biological drugs in a few years. However, there is still a long way for doctors to implement PM in routine care, mostly due to the lack of approved diagnostic markers. (5) Promising data suggests that PM could also play a role in treating the aesthetically disfiguring and psychologically damaging scars. New predictive biomarkers may help clinicians to predict the risk of skin scar formation and then tailor the antifibrotic treatment strategies to each patient. (6)


The potential of personalized medicine has led scientists to always look upon it as the future of medicine, however with the major progress in technology, allowing us to sequence our entire genome in few hours, it is undeniably the present for some debilitating diseases. Many success stories highlight the importance of PM in dermatology, starting from the treatment of skin cancer to the prevention of skin scars, however, there is still a long way for the implementation of it in general dermatological care. Constant studies on gene-disease-treatment interactions are needed, to further explore the undeniable value of personalized medicine.


References:


1. Litman, T. Personalized medicine—concepts, technologies, and applications in inflammatory skin diseases. APMIS vol. 127 386–424 (2019).

2. Mathur, S. & Sutton, J. Personalized medicine could transform healthcare (Review). Biomed. Reports 7, 3–5 (2017).

3. Helgadottir, H., Trocoli Drakensjö, I. R. & Girnita, A. Personalized medicine in malignant melanoma: Towards patient tailored treatment. Front. Oncol. 8, (2018).

4. Cheng, L., Lopez-beltran, A., Massari, F., Maclennan, G. T. & Montironi, R. Molecular testing for BRAF mutations to inform melanoma treatment decisions : a move toward precision medicine. Nat. Publ. Gr. 31, 24–38 (2017).

5. Garzorz-Stark, N. & Eyerich, K. Personalized medicine in the field of inflammatory skin diseases. Hautarzt vol. 70 15–20 (2019).

6. Amini-Nik, S. Time heals all wounds- but scars remain. Can personalized medicine help? Front. Genet. 9, 1–3 (2018).

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