Concurrent chronic hyperplastic candidosis and oral lichenoid lesion as adverse events of secukinumab therapy

Abstract

Secukinumab (Cosentyx®) is an IL‐17A inhibitor which is used for the management of psoriasis, active psoriatic arthritis or ankylosing spondylitis. Oral adverse events of secukinumab therapy are not widely appreciated. This article highlights the presentation of two concurrent oral adverse events of secukinumab therapy; namely chronic hyperplastic candidosis (CHC) and oral lichenoid lesion (OLL). This is the first documented case report of CHC occurring as a consequence of secukinumab therapy, and represents a new adverse effect which general and specialist oral health practitioners should be aware of. This case highlights the importance of correlating the presence of oral lesions with the patient’s medical history, keeping up to date with the development of new medications and pharmacotherapeutics, having a deep understanding of underlying biological processes related to various oral diseases, and appreciating the use of clinical adjunctive devices. Accurate diagnosis is key to formulating a correct management plan.

Oral Candida Infection in Psoriatic Patients Treated with IL17A Inhibitors: Report of 3 Cases and a Comprehensive Review of the Literature

“…Overall, it appears that the majority of aforementioned OC cases, including ours, affected the tongue, followed by the buccal and palatal mucosa and the commissures. In particular, a clinical presentation of CHC, i.e., a non-detachable (or only partially removable) white plaque, appears to be common [ 58 , 60 ], similar to our case #1, while a co-existence of oral lichenoid lesions is also possible [ 27 , 60 , 61 ]. This propensity for relatively unusual or atypical clinical features, compared to the more typical pseudomembranous or erythematous OC, necessitates ruling out other conditions with clinical similarities.…”

“…Besides clinical trials, the number of case series and reports specifically addressing the development of OC in patients receiving anti-IL17A regimens remains very limited [ 27 , 58 , 59 , 60 , 61 , 62 ]. In this regard, our three cases represent uncommonly reported examples of microscopically proven OC with the characteristic clinical appearance in patients without any other predisposing factor besides anti-IL17A treatment, while case #3 is the first well-documented OC related to brodalumab published to this date.…”

“…In a detailed case series of 16 psoriatic patients [ 59 ], two of which had predisposing factors for candidiasis (the one was diabetic and the other had recently completed a 3-month treatment with steroids), none of them developed oral (or other mucosal or cutaneous) Candida infection, as assessed by swabs and culture, during the 12-month therapy periods with subcutaneous injections of secukinumab 300 mg monthly. Recently, a case of microscopically confirmed OC in a 52-year-old female patient with psoriasis treated with secukinumab (300 mg monthly) was reported by Farah [ 60 ]. Specifically, a thick white plaque on the dorsal tongue, consistent with CHC, was noticed and successfully treated with oral fluconazole 50 mg per day for 3 weeks; maintenance of the targeted immunotherapy was decided, and no recurrences were noticed.…”

“…In relation to the possible need for drug discontinuation, it seems that OC does not necessarily constitute a reason to discontinue the anti-IL17A inhibitors, as in the case reported by Farah [ 60 ]. However, in the other four reported cases [ 27 , 58 , 61 , 62 ], discontinuation of the treatment was elected, followed by adjustment of the dosage [ 58 ] or replacement of the medication with other of the same [ 27 ] or other class [ 62 ].…”

Detection of IL-17A and IL-17F gene polymorphism in recurrent and disseminated pityriasis versicolor: a case-control study

“…Rapid onset of widespread tinea versicolor has been encountered in a psoriatic patient following a switch from ustekinumab to ixekizumab [ 25 ]. Another psoriatic patient on secukinumab was reported to present with atypical oral candidiasis, which improved remarkably following lowering the monthly dose of secukinumab to 150 mg [ 26 ] as well as another case of psoriasis who experienced co-existing chronic hyperplastic candidosis and an oral lichenoid lesion, as side effects of the secukinumab therapy, which the patient was subjected to [ 27 ]. These reports emphasize the importance of IL-17 in the pathogenesis of PV as well as other superficial fungal infections.…”