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

Abstract

An intact and fully functional immune system plays a crucial role in the prevention of several infectious diseases. Interleukin (IL)17 is significantly involved in oral mucosa immunity against several antigens and microorganisms, including Candida albicans (CA). Herein, we present three cases of oral candidiasis (OC) related to the use of an IL17A inhibitor for psoriasis. Three psoriatic individuals presented for evaluation of widespread symptomatic oral lesions temporally correlated with the onset of IL17A inhibitors (secukinumab in two patients and brodalumab in one patient). Clinical examination revealed either partially removable white plaques in an erythematous background (case #1) or diffuse erythematous lesions (cases #2 and 3) involving several areas of the oral mucosa. Cytology smear, accompanied by histopathologic examination in case #1, confirmed the clinical impression of OC in all three cases. All patients received antifungal therapy with satisfactory clinical response. No discontinuation of the antipsoriatic regimen was recommended, but all patients were advised to remain under monitoring for possible OC relapses. During the last few years, new systemic biologic agents targeting IL17 have been used for the management of variable immune-mediated diseases. Few clinical trials and scarce case reports have shown that these medications place individuals at high risk of developing candidiasis. We propose that patients treated with these medications should be at close monitoring for the development of OC and, if it occurs, receive appropriate management.

Secukinumab‐induced oral lichen planus in a psoriatic arthritis patient ameliorated after a switch to risankizumab

“…One of the key cytokines that determines the mycobiome is IL‐17, which plays a protective role against fungal infections on the mucosal surface 2,11 . Although there have been no investigations on whether secukinumab alters the mycobiome in the oral cavity, the use of anti‐IL‐17 agents generally increases candidal infections in clinical settings, with a frequency of oral candidiasis during secukinumab reported as up to 5%, which is higher than in healthy controls 12 . Therefore, the blockage of IL‐17 can trigger or exacerbate OLP.…”

“…2, 11 Although there have been no investigations on whether secukinumab alters the mycobiome in the oral cavity, the use of anti-IL-17 agents generally increases candidal infections in clinical settings, with a frequency of oral candidiasis during secukinumab reported as up to 5%, which is higher than in healthy controls. 12 Therefore, the blockage of IL-17 can trigger or exacerbate OLP. Indeed, two OLP cases concomitant with oral candidiasis have been reported in patients treated with secukinumab, as in our case.…”

Risk of candidiasis associated with interleukin-17 inhibitors: Implications and management

“…The link between candidiasis and IL-17 inhibitors has prompted concerns among physicians and patients regarding possible adverse reactions to these drugs (Saeki et al 2023 ). However, it is noteworthy that not all IL-17 inhibitors treated individuals are susceptible to candidiasis, and the risk of infection may differ based on the patient’s underlying condition, the dose and duration of therapy, and the type of IL-17 inhibitors (Pettas et al 2021 ).…”