Psoriasis is an inflammatory disease with both skin and joint manifestations. Focused biologics have been developed to target specific
cytokines implicated in
psoriasis and are becoming increasingly utilized. Recently, the advent of newer biologics, including
IL-17,
IL-12/IL-23, and
IL-23 inhibitors, have garnered interest as promising treatments for
psoriasis and other inflammatory conditions. Although
IL-17 and
IL-23 have been studied in the pathophysiology of
psoriasis, they also play a central role in immunologic defenses, including those against fungi. Therefore, use of these
interleukin inhibitors may theoretically impair the immune system against deep
fungal infections. We reviewed the available literature investigating the risk for
invasive fungal infections in patients treated with
IL-17 and
IL-23 inhibitors for
psoriasis or other inflammatory conditions. Randomized controlled trials (RCTs), including extended trials and clinical trials, were reviewed, and we found that although there was a small number of patients who developed superficial
candidiasis, there were no reports of invasive
fungal disease. Although these results support the safety and the low risk for deep
fungal infection with these biologics, caution is still warranted, as these medications are relatively new. Appropriate screening and management of
fungal disease should still be practiced when utilizing these medications in the treatment of
psoriasis and other inflammatory conditions.