Should we be monitoring patients on systemic dermatologic therapies for psychiatric adverse effects?: a proposed clinical framework

OBJECTIVES: Systemic therapies have transformed dermatologic practice by providing effective treatment for several conditions, including autoimmune diseases, inflammatory disorders, and severe cutaneous emergencies. Despite their therapeutic benefits, these agents may cause psychiatric adverse effects that complicate clinical management. METHODS: We conducted an initial literature review synthesizing psychiatric adverse effects of systemic dermatologic medications-including corticosteroids, immunosuppressants, Janus kinase inhibitors, antihistamines, antimalarials, dapsone, isotretinoin, and biologics-and proposed a clinical framework for the screening and monitoring of these complications. RESULTS: Psychiatric adverse effects vary across systemic therapies. Corticosteroids are associated with mood disturbances, psychosis, and delirium, with psychiatric symptoms occurring in nearly 20% of patients receiving high-dose therapy. Isotretinoin remains controversial because of its potential association with depression and suicidality. Other systemic agents have been reported to cause a range of neuropsychiatric effects, although the frequency and strength of evidence differ among medications. CONCLUSIONS: Overall, psychiatric adverse effects represent an important consideration in the use of systemic dermatologic therapies. Awareness of these potential complications, coupled with appropriate screening and monitoring, is essential for early recognition and effective management. Improved understanding of medication-related psychiatric effects can help dermatologists optimize treatment outcomes while enhancing patient safety.