In response to various microenvironmental stimuli, macrophages are highly plastic and primarily polarized into the pro-inflammatory M1-type and the anti-inflammatory M2-type, both of which perform almost entirely opposing functions. This characteristic determines that macrophages carry out various tasks during various stages of immunity and inflammation. An imbalance in the M1/M2 macrophage ratio is often observed in inflammatory immune skin diseases, and modulation of the macrophage polarization phenotype exacerbates or alleviates the associated symptoms. Therefore, this review presents the mechanisms of macrophage polarization, inflammation-related signaling pathways (JAK/STAT, NF-κB, PI3K/Akt) and the role of both in inflammatory immune skin diseases (psoriasis, AD, SLE, BD, etc.) with the aim of providing new directions for basic and clinical research of related diseases.