Biologic Safety — SCE Dermatology MCQ

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ModerateDermatopharmacologyBiologic SafetySCE Dermatology

A 45-year-old man with plaque psoriasis is on Secukinumab. He develops recurrent oral candidiasis. This is a recognised class effect of which biologic class?

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Correct answer: C — IL-17 inhibitors (due to IL-17's role in mucocutaneous anti-Candida defence)

Candida infections (mucocutaneous candidiasis, particularly oral) are a recognised class effect of IL-17 inhibitors (Secukinumab, Ixekizumab, Brodalumab, Bimekizumab). This is because IL-17A plays a critical role in mucocutaneous anti-Candida immunity — patients with genetic IL-17 pathway defects (chronic mucocutaneous candidiasis/CMC) are highly susceptible to Candida infections. The incidence of candidiasis with IL-17 inhibitors is approximately 3-4% (higher with Bimekizumab ~15% due to dual IL-17A/F blockade). Most cases are mild and manageable with topical or oral antifungals without requiring biologic cessation. Patients should be counselled about this risk and advised to seek treatment for oral symptoms.

Reference: BAD 2020 Biologic Guidelines; BNF