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Updated: Sep 18, 2025

The Goeckerman Regimen for the Treatment of Moderate to Severe Psoriasis
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The Goeckerman Regimen for the Treatment of Moderate to Severe Psoriasis

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Biologic Therapy and Superficial Fungal Infection Risk in Moderate-to-Severe Psoriasis: A Meta-Analysis

Heli Liu1, Long Zhou1, Ziping Song1

  • 1Department of Dermatology and Venereology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China.

Mycoses
|June 21, 2025
PubMed
Abstract

Insights

Biologic agents, especially interleukin-17 (IL-17) inhibitors, significantly increase the risk of superficial fungal infections like Candida in psoriasis patients. Close monitoring for fungal infections is crucial during treatment.

Area of Science:

  • Dermatology
  • Immunology
  • Infectious Diseases

Background:

  • Biologic agents are crucial for moderate-to-severe plaque psoriasis.
  • The risk of superficial fungal infections with these agents is not fully understood.
  • This study systematically evaluates fungal infection risks associated with different biologics.

Purpose of the Study:

  • To systematically assess the impact of various biologic agents on superficial fungal infection risks in psoriasis patients.
  • To compare the infection risks between different classes of biologics, including anti-IL-17, anti-IL-12/23, and anti-TNF agents.
  • To provide evidence for targeted monitoring and management strategies.

Main Methods:

  • Systematic literature search of PubMed, EMBASE, Cochrane Library, and Web of Science up to December 2024.
  • Keywords included 'psoriasis', 'biologics', 'anti-IL-17', 'anti-IL-12/23', 'anti-TNF', 'superficial fungal infections', 'Candida', and 'dermatophyte infections'.
  • Meta-analyses were conducted using RevMan 5.4 and STATA 16.0 software.

Main Results:

  • Twenty-nine randomized controlled trials (RCTs) involving 644 records were analyzed.
  • Interleukin-17 (IL-17) inhibitors significantly increased Candida infection risk (OR=2.39) compared to placebo.
  • IL-17 inhibitors showed a higher risk of Candida infections than TNF-α (OR=2.23) and IL-12/23 (OR=4.21) inhibitors.
  • Biologic agents overall increased the risk of superficial fungal infections (OR=2.10).

Conclusions:

  • Biologic agents, particularly IL-17 inhibitors, elevate the risk of superficial fungal infections in psoriasis patients.
  • Clinical practice should incorporate targeted monitoring protocols for early detection of fungal infections.
  • Prompt antifungal treatment is recommended when superficial fungal infections are identified.
Keywords:
Candida infectionsbiologicsdermatophyte infectionsmeta‐analysispsoriasissuperficial fungal infections

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