B-cell-targeted therapies in the treatment of autoimmune skin diseases – a comprehensive review of mechanisms, efficacy, and future directions

Autoimmune skin diseases (AISDs) constitute a complex group of conditions whose pathogenesis is based on abnormal activation of the immune system, leading to the production of autoantibodies and damage to skin structures. In recent years, a key role in these processes has been attributed to B lymphocytes, which not only produce autoantibodies but also perform regulatory and effector functions in the immune response. The development of biological therapies targeting B lymphocytes has revolutionized the treatment of many diseases, particularly pemphigus, where anti-CD20 antibodies have become the standard of care. The aim of this article is to provide a comprehensive overview of the role of B lymphocytes in the pathogenesis of AISD, an overview of available targeted therapies (including monoclonal antibodies, kinase inhibitors, and plasma cell-targeted therapies), and an analysis of their efficacy, safety, and limitations. Attention was paid to new therapeutic strategies that may enable more selective and sustained modulation of the immune response.