Where is Precision Medicine Today in Dermatology?

Precision medicine has become an increasingly popular topic of discussion in medicine, with some viewing it as the way of the future and others as a pipe dream.

In dermatology, precision medicine has become increasingly mentioned during sessions held at major yearly meetings. It is also referred to sometimes as “personalized medicine,” though the use of “precision medicine” as a moniker has become prevalent given its reference to tailoring therapies based on individual characteristics, rather than the creation of unique drugs for each patient.1

As the topic has become more commonplace at dermatology conferences, more and more have become aware that precision medicine refers to the “ability to classify individuals into subpopulations that differ in their susceptibility to a particular disease, in the biology and/or prognosis of those diseases they may develop, or in their response to a specific treatment.”1

Dermatologists have highlighted the wide array of targeted immunomodulatory drugs in existence today, shaping the chronic inflammatory skin disease landscape.2 However, as a paper published in Springer Nature noted, selection of therapies in fields like dermatology remains primarily empirical and commonly guided by trial-and-error and mandates related to insurance versus individual patients’ underlying biology.

Personalized medicine has been touted as an answer to all of this. But the question remains: Where are we today and how far do we have to go? In this feature, there is a synthesis of recently published papers and discussions with several leading experts in dermatology, all of whom were asked about their views on what personalized medicine looks like in the modern era and whether or not it is a realistic aim for the field.

Why Dermatology Lags Behind Other Fields in Precision Medicine

“In science fiction, somebody gets a body scan and knows exactly what's wrong,” said Peter Lio, MD, clinical assistant professor of dermatology and pediatrics at Northwestern University Feinberg School of Medicine, told HCPLive.3 “That's really the goal: personalizing to you what would be safe and effective, the right solution to your specific problem.”

While the benefits of personalizing treatment plans for dermatology patients are widely acknowledged, precision medicine has seen greater leaps in advancement in other medical subfields. Oncology, for example, has been referred to as being at the forefront of precision medicine.4

“In other fields of medicine, particularly oncology, we've seen the biggest leaps in precision medicine, being able to understand tumor characteristics and say, you have this mutation, so this pathway is exactly what you need... oncology is setting the tone for everybody else, but I don't think we're anywhere close to that yet with inflammatory conditions.”5

Of course the mutation-driven nature of cancer is, in part, to blame for its supremacy in this area. Cancer is fundamentally a genomic disease, with tumors often maintaining a small number of driver mutations which can be targeted in a more direct manner.4

Meanwhile, skin disease is considered messier. Most chronic skin diseases, such as psoriasis, chronic urticaria, and atopic dermatitis, are known to be driven by overlapping networks of cytokines such as interleukin TNF-alpha, (IL)-17, and others, as opposed to a single mutation.6

There is a limited specificity of common proinflammatory markers across these different conditions, a review of dermatology biomarkers suggested.5 The review concluded that the same biomarker often cannot cleanly divide 1 disease or treatment-response subgroup from another.

Nevertheless, precision dermatology is still seeing some advancement in an oncology-related area, as gene expression profiling (GEP) for cutaneous tumors and artificial intelligence (AI) use for lesion diagnosis have seen some key insights helping to expand dermatology’s precision medicine potential.7

Trial-and-Error Treatment Selection in Inflammatory Skin Disease

While common skin diseases, or dermatoses, are typically seen as non-life-threatening when compared to cancer, their effects on patients’ physical and mental health outcomes, as well as quality of life and economic productivity, are substantial.

Recent research in the field of dermatology has demonstrated the multidimensional nature of skin disease burden, especially for those living with diseases such as psoriasis and atopic dermatitis.8 The detrimental impacts of inflammation dermatoses also have disproportionate impacts on women, as 1 study demonstrated, with such diseases leading to significant increases in absenteeism, impairment at work, and activity impairment.

Given both their pervasiveness and the complexity of their diagnoses and therapeutic decision-making pathways, psoriasis and atopic dermatitis have particularly singled out as warranting an increased precision medicine approach. This is especially the case because despite the growing armamentarium of biologics and Janus kinase (JAK) inhibitors, these approvals have not solved a core problem in dermatology: knowing which therapy to initiate first.

Insurance “step therapy” is a system often which often locks this issue in place, leading to a requirement for those with psoriasis to fail an older TNF-alpha inhibitor such as adalimumab prior to payers approving an IL-17 or 23 inhibitor.

These are exactly the types of gaps precision medicine could potentially close.2 Rather than a process of cycling patients through biologics by trial and error, biomarker testing and disease endotyping could help to identify, before therapy use begins, which pathway is actually driving a given patient's disease.

Where Are We Now? The Emerging Toolkit in Precision Dermatology

"I think we're finally beginning to see enough choices to start having precision medicine discussions,” Peter Lio, MD, expressed when asked about precision dermatology today.

Despite the lag behind fields such as oncology, dermatology has seen limited progress in the precision medicine arena. There have been several notable efforts to illustrate what precision medicine could look like in dermatology, including a genetic test of a patient's skin to predict which medication class could work and a diagnostic patch doing the same thing for psoriasis.

Preliminary data on the genetic test, designed by Castle Biosciences, have been described as promising.9 According to 1 review, Castle is is “running a multi-site longitudinal clinical study to determine the utility of skin scrapings in inflammatory dermatoses, with the hypothesis that a multi-algorithmic gene expression profile…can be identified to guide systemic therapy selection in patients with psoriasis, [atopic dermatitis], and related conditions.”

At the same time, Mindera Health is a company which has worked on the development of the ‘Mind.Px’ dermal patch testing method, with the aim being to identify psoriasis treatment response genes. They too have yielded positive findings. While both companies’ approaches differ, they both have been singled out as minimally invasive tools designed to analyze genetic biomarkers in dermatology.

In a discussion with HCPLive, Christopher Bunick, MD, PhD, associate professor of dermatology at Yale School of Medicine, appeared to concur with these types of findings, describing advances in transcriptomics and cellular immunology as areas that could play a significant role in the future of dermatologic therapy prediction.10

Precision Dermatology's Path from Research to Clinical Practice

Despite advances in testing and leaps forward such as the Castle Biosciences and Mindera Health methods, doubts remain regarding precision medicine as a fully realized idea in the dermatology space.

"I think the precision medicine journey is something that will probably never hit an end point,” Peter Lio, MD, explained.3 “It's going to be a continuous journey of refinement and improvement, much like the virtuous cycle of drug development: we get a new medicine, it teaches us more about the underlying disease state, and that in turn allows us to refine and get better medicines. It's a building process. Rarely do we have a breakthrough that solves the whole thing; most of what I'm involved in never works that way, it's a slow process of iteration.”

Other dermatologists, such as Eingun James Song, MD, associate chief medical officer and the director of clinical research at Frontier Dermatology, have echoed these sentiments regarding the potential for personalized care for dermatology patients.

“I think personalized medicine is going to be the best way to improve patient treatment outcomes, because hopefully we can predict what type of patients are going to respond the best,” Song noted to HCPLive. “But also [we need to ensure] the least amount of side effects to a certain drug based on their patient profile.”11

While views expressed by clinicians such as Lio and Song highlight the cautiousness expressed by many in the field, others have nonetheless stressed the importance of finding an alternative to the trial-and-error method chaining dermatologists to the step therapy system required by health insurance companies. Jason Hawkes, MD, professor of dermatology at the University of California, Davis, described his own frustration with this system to HCPLive.12

“We need some metrics or measures or testing that can help us better select therapies at the outset that have a higher likelihood of working because we just want to get those patients better,” Hawkes expressed, noting clinicians’ inability to look at a patient’s whole needs when restricted in this manner. “We're in a try-and-fail system, and we don't always know they can look like they're going to respond and not respond.”

Although the dermatology field will not jump directly ahead to the oncology model of matching a single mutation to a single treatment in 1 day, advancements continue to appear in precision dermatology. Between tests already arriving in dermatology clinics, medications built around newly mapped immune pathways, and literature pushing further into proteomics and cellular immunology, the field of skin health slowly but surely evolving toward a more personalized future for patients.

Editor’s note: The clinicians quoted had no relevant financial disclosures of note

References

1. National Research Council (US) Committee on A Framework for Developing a New Taxonomy of Disease. Toward Precision Medicine: Building a Knowledge Network for Biomedical Research and a New Taxonomy of Disease. Washington (DC): National Academies Press (US); 2011. Appendix E, Glossary. https://www.ncbi.nlm.nih.gov/books/NBK92148/.

2. Yuan M, Lee J, Cheng JB, et al. Advancing Precision Medicine in Inflammatory Skin Disease. Am J Clin Dermatol. 2025 Nov;26(6):853-861. doi: 10.1007/s40257-025-00963-7. Epub 2025 Aug 17. PMID: 40819342; PMCID: PMC12615522.

3. Lio P. Q&A: Precision Medicine's Next Steps in Atopic Dermatitis, With Peter Lio, MD. HCPLive. September 10, 2026. Accessed September 15, 2026. https://www.hcplive.com/view/q-a-precision-medicine-next-steps-atopic-dermatitis-peter-lio-md.

4. Zakria D, Brownstone N, Lebwohl M. Integrating Precision Medicine into Medical Dermatology Clinical Practice: An Expert Consensus Panel. J Drugs Dermatol. 2023 Jun 1;22(6):588-593. doi: 10.36849/JDD.7432. PMID: 37276166.

5. Lio P. The Present and Future of Precision Medicine in Dermatology, With Peter Lio, MD. HCPLive. September 1, 2026. Accessed September 15, 2026. https://www.hcplive.com/view/present-future-precision-medicine-dermatology-peter-lio-md.

6. Tan IJ, Podwojniak A, Cohen BA, et al. Precision Dermatology: A Review of Molecular Biomarkers and Personalized Therapies. Curr Issues Mol Biol. 2024 Mar 30;46(4):2975-2990. doi: 10.3390/cimb46040186. PMID: 38666916; PMCID: PMC11049353.

7. Mehrmal S, Tan MG, Tolkachjov SN, et al. Gene Expression Profiling (GEP) in Dermatology, Part 1: Introduction, Development, Benefits, Limitations, and Future Directions of GEP. J Am Acad Dermatol. 2025 Oct 27:S0190-9622(25)03081-6. doi: 10.1016/j.jaad.2025.10.084. Epub ahead of print. PMID: 41161602.

8. Padovan M, Benincasa BB, Foddis R, et al. Assessing the burden of dermatological diseases on work life from a gender perspective. Sci Rep. 2025 Jul 5;15(1):24014. doi: 10.1038/s41598-025-07804-x. PMID: 40617854; PMCID: PMC12228698.

9. Haran K, Kranyak A, Liao W, et al. Commercial Diagnostics and Emerging Precision Medicine Technologies in Psoriasis and Atopic Dermatitis. Psoriasis (Auckl). 2024 Aug 5;14:87-92. doi: 10.2147/PTT.S478377. PMID: 39132449; PMCID: PMC11314430.

10. Bunick C. What Will Precision Dermatology Look Like in Atopic Dermatitis? HCPLive. June 25, 2026. Accessed September 15, 2026. https://www.hcplive.com/view/what-will-precision-dermatology-look-like-atopic-dermatitis-

11. Smith T. Eingun James Song, MD: Upcoming Treatments for Psoriasis. HCPLive. January 16, 2024. Accessed September 15, 2026. https://www.hcplive.com/view/eingun-james-song-md-upcoming-treatments-for-psoriasis.

12. Hawkes J. Q&A: How Is Precision Medicine Changing Atopic Dermatitis Care? With Jason Hawkes, MD. HCPLive. July 24, 2026. Accessed September 15, 2026. https://www.hcplive.com/view/q-a-how-precision-medicine-changing-atopic-dermatitis-care-jason-hawkes-md.