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At the 2024 Winter Clinical Derm Conference, April Armstrong, MD, MPH, and Joseph F. Merola, MD, MMSc, presented “Debate: IL-17 vs IL-23 Blockers for Psoriasis.”
At the 2024 Winter Clinical Dermatology Conference, held January 12-17, 2024 in Honolulu, April Armstrong, MD, MPH, and Joseph F. Merola, MD, MMSc, presented “Debate: IL-17 vs IL-23 Blockers for Psoriasis.”
Drs. Armstrong and Merola published two papers recently that address this topic, which we summarize here:
Interleukin (IL)-17 Versus IL-23 Inhibitors: Which Is Better to Treat Patients With Moderate-to-Severe Psoriasis and Mild Psoriatic Arthritis in Dermatology Clinics?
J Rheumatol. 2023;50(Suppl2):11-13.
Both Interleukin (IL)-17 and IL-23 inhibitors have received approval for managing moderate-to-severe plaque psoriasis (PsO) and psoriatic arthritis (PsA). However, without direct comparative studies, the optimal choice for treating patients with moderate-to-severe PsO and mild PsA remains uncertain. At the 2022 Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) conference, Dr. April Armstrong and Dr. Joseph Merola engaged in a debate regarding the preferred biologic class for this patient population. Dr. Armstrong advocated for IL-17 inhibition, while Dr. Merola presented arguments in favor of IL-23 inhibition. This manuscript provides an overview of their primary arguments.
A Practical Guide to the Management of Oral Candidiasis in Patients with Plaque Psoriasis Receiving Treatments That Target Interleukin-17
Dermatol Ther (Heidelb). 2022;12(3):787-800.
Plaque psoriasis, an immune-mediated inflammatory skin condition, is linked to cytokine dysregulation, notably within the interleukin (IL)-23/IL-17 pathways. Biologic therapies targeting these pathways have gained attention in recent years. However, inhibiting cytokines in the IL-23/IL-17 pathways may heighten the risk of fungal infections, particularly oral candidiasis, in patients. Therefore, it is crucial for dermatology practitioners to proficiently diagnose and treat oral candidiasis. This review explores the IL-23/IL-17 pathways’ role in antifungal host defense and offers a practical guide for diagnosing and treating oral candidiasis in psoriasis patients. Although treatment with anti-IL-17 medications may elevate oral candidiasis incidence in psoriasis patients, these cases are typically mild or moderate and can be effectively managed with standard antifungal therapy without discontinuing psoriasis treatment. If applicable, psoriasis patients should be advised on maintaining good oral hygiene, managing co-existing diabetes, and provided with information on smoking cessation to prevent oral candidiasis.
