Cutaneous Adverse Reactions to IL-17 and IL-23 Inhibitors: A Clinical Review of Reaction Patterns.
5 affiliations
- 1David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
- 2Cumming School of Medicine, University of Calgary, Calgary, AB, CA.
- 3University of Illinois College of Medicine at Chicago, Chicago, IL, USA.
- 4University of Kansas School of Medicine, Kansas City, KS, USA.
- 5University of California Los Angeles, Los Angeles, CA, USA.
Abstract
Introduction
IL-17 and IL-23 inhibitors have transformed the management of moderate-to-severe psoriasis and other inflammatory diseases through targeted immune modulation. Although generally well tolerated, an expanding spectrum of cutaneous adverse reactions has been reported, ranging from common paradoxical eruptions to rare immune-mediated dermatoses that may mimic primary inflammatory or autoimmune conditions.Objectives
We present a narrative review of cutaneous adverse reactions associated with IL-17 and IL-23 inhibitors. This review aims to summarize reported reaction patterns, proposed mechanisms, clinical and histopathologic features, and current diagnostic and therapeutic considerations to support clinical decision-making.Methods
We performed a narrative review of English-language literature describing cutaneous adverse reactions associated with IL-17, IL-23, and IL-12/23 inhibitors indexed in PubMed, Google Scholar, and Web of Science from database inception through August 2025. Clinical trials, observational studies, case series, case reports, and reviews were evaluated, and findings were synthesized according to reaction phenotype.Results
Psoriasiform and eczematous eruptions represent the most frequently reported cutaneous adverse reactions and may be clinically and histologically indistinguishable from idiopathic dermatoses. Less commonly reported reactions include lupus-like syndromes, bullous pemphigoid, lichenoid drug reactions, granulomatous eruptions, and vasculitic presentations, including IgA vasculitis. Proposed mechanisms involve paradoxical alterations in immune signaling following cytokine blockade rather than direct drug toxicity, although definitive pathways remain incompletely understood. Management strategies vary according to severity and phenotype, ranging from topical therapies and continued biologic use to discontinuation of the offending agent and systemic immunosuppression.Conclusions
IL-17 and IL-23 inhibitors are associated with a diverse spectrum of cutaneous adverse reactions that require recognition due to their potential overlap with primary dermatologic diseases. A structured approach to diagnosis and management may facilitate timely intervention. Further studies are needed to clarify incidence, risk factors, mechanisms, and evidence-based treatment strategies.
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BibTeX
@article{park2026cutaneous,
title = {{Cutaneous Adverse Reactions to IL-17 and IL-23 Inhibitors: A Clinical Review of Reaction Patterns.}},
author = {Ingyun Park and Ali Bayrouti and Duncan MacIntyre and Vivian Le and Khoa B Nguyen},
journal = {Dermatology practical \& conceptual},
year = {2026},
month = jul,
doi = {10.5826/dpc.1603a6731},
url = {https://europepmc.org/article/MED/42858381},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Cutaneous Adverse Reactions to IL-17 and IL-23 Inhibitors: A Clinical Review of Reaction Patterns.
AU - Ingyun Park
AU - Ali Bayrouti
AU - Duncan MacIntyre
AU - Vivian Le
AU - Khoa B Nguyen
PY - 2026
DA - 2026/07/31
JO - Dermatology practical & conceptual
DO - 10.5826/dpc.1603a6731
UR - https://europepmc.org/article/MED/42858381
AB - Introduction IL-17 and IL-23 inhibitors have transformed the management of moderate-to-severe psoriasis and other inflammatory diseases through targeted immune modulation. Although generally well tolerated, an expanding spectrum of cutaneous adverse reactions has been reported, ranging from common paradoxical eruptions to rare immune-mediated dermatoses that may mimic primary inflammatory or autoimmune conditions.Objectives We present a narrative review of cutaneous adverse reactions associated with IL-17 and IL-23 inhibitors. This review aims to summarize reported reaction patterns, proposed mechanisms, clinical and histopathologic features, and current diagnostic and therapeutic considerations to support clinical decision-making.Methods We performed a narrative review of English-language literature describing cutaneous adverse reactions associated with IL-17, IL-23, and IL-12/23 inhibitors indexed in PubMed, Google Scholar, and Web of Science from database inception through August 2025. Clinical trials, observational studies, case series, case reports, and reviews were evaluated, and findings were synthesized according to reaction phenotype.Results Psoriasiform and eczematous eruptions represent the most frequently reported cutaneous adverse reactions and may be clinically and histologically indistinguishable from idiopathic dermatoses. Less commonly reported reactions include lupus-like syndromes, bullous pemphigoid, lichenoid drug reactions, granulomatous eruptions, and vasculitic presentations, including IgA vasculitis. Proposed mechanisms involve paradoxical alterations in immune signaling following cytokine blockade rather than direct drug toxicity, although definitive pathways remain incompletely understood. Management strategies vary according to severity and phenotype, ranging from topical therapies and continued biologic use to discontinuation of the offending agent and systemic immunosuppression.Conclusions IL-17 and IL-23 inhibitors are associated with a diverse spectrum of cutaneous adverse reactions that require recognition due to their potential overlap with primary dermatologic diseases. A structured approach to diagnosis and management may facilitate timely intervention. Further studies are needed to clarify incidence, risk factors, mechanisms, and evidence-based treatment strategies.
SN - 2160-9381
ER -