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Discussion

There are sparse reports of oral adverse events associated with new anti–IL-17 drugs (Table I). 1, 2, 3 However, oral adverse effects of other biologic agents such as TNF inhibitors, which have longer track records, are well described (Table I). 4, 5, 6, 7, 8 Mouth ulceration was reported in 2 patients in a phase 2 secukinumab trial, but specifics were not provided. 1 The differential diagnosis of our patient's labial lesions includes candidiasis, oral lichen planus (LP), drug-induced LP, lichenoid contact dermatitis, erythema multiforme (EM), major aphthae, complex aphthosis, pemphigus vulgaris (PV), and mucous membrane pemphigoid (MMP). Oral candidiasis, reported in 1.8% of patients at 52 weeks in a secukinumab trial, 2 was ruled out by negative potassium hydroxide preparation and fungal culture, and no response to oral fluconazole.