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Mechanisms Underlying Lichen Planus in Association with Biologic Therapy.
Alexa S Podolsky1, Shari R Lipner2
1Renaissance School of Medicine, Stony Brook University, New York, NY, USA.
Journal of Inflammation Research
|November 3, 2025
Summary
Biologic therapies can cause lichen planus (LP), a skin condition. This review summarizes evidence on drug-induced LP, potential immune mechanisms, and management strategies for this cutaneous reaction.
Area of Science:
- Dermatology
- Immunology
- Pharmacology
Background:
- Cutaneous reactions, such as lichen planus (LP) and lichenoid eruptions, are increasingly linked to biologic therapies.
- Biologic agents implicated include immune checkpoint inhibitors and tumor necrosis factor-α inhibitors.
- The precise immunological mechanisms driving these reactions are not fully understood.
Purpose of the Study:
- To systematically review current evidence on biologic-associated LP.
- To identify implicated drug classes.
- To propose potential immunological mechanisms and management strategies.
Main Methods:
- A comprehensive systematic literature analysis of PubMed was performed.
- 145 publications were reviewed, identifying 157 cases of biologic-associated LP.
- Overlapping immunological mechanisms were proposed based on the reviewed literature.
Main Results:
- Several immunological mechanisms are implicated in biologic-induced LP, including cytokine imbalances, altered T cell pathways, antigen unmasking, and keratinocyte apoptosis dysregulation.
- Host susceptibility factors may also play a role.
- Management typically involves discontinuing the biologic agent and implementing adjunctive therapies.
Conclusions:
- Biologic therapies are associated with cutaneous reactions like LP, necessitating further investigation into underlying mechanisms.
- Clarifying these pathways, determining incidence, and identifying predictive biomarkers are crucial for risk stratification and patient management.
- Continued research is essential to refine understanding and treatment of biologic-induced LP.
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