Drug therapies and immune pathways in ocular manifestations of inflammatory skin diseases

INTRODUCTION: Inflammatory skin diseases and ocular disorders frequently coexist due to shared embryological origins, overlapping immune pathways, and common barrier functions. The increasing use of targeted systemic therapies in dermatology has further highlighted the skin-eye interface, introducing both therapeutic benefits and iatrogenic ocular complications. AREAS COVERED: This review outlines the shared embryological and immunological mechanisms linking the skin and ocular surface, with emphasis on major inflammatory pathways, including TNF-α, Th17, and JAK-STAT signaling. We summarize the prevalence and spectrum of ocular involvement across common inflammatory skin diseases such as psoriasis, atopic dermatitis, rosacea, pemphigus vulgaris, and ocular mucous membrane pemphigoid. In addition, we evaluate ocular adverse effects associated with commonly used dermatologic therapies, highlighting the emerging phenomenon of iatrogenic and paradoxical inflammation. EXPERT OPINION: Ocular manifestations arising from both disease-associated and iatrogenic etiologies remain underrecognized in clinical practice. Early recognition, interdisciplinary collaboration, and risk-adapted strategies, including care accessibility and patient education, are essential to prevent vision-threatening complications. A shift from reactive care to proactive, risk-stratified screening based on individual patient risk profiles can improve clinical outcomes across the skin-eye axis.