Australasian Journal of Dermatology | 2019
Necrobiotic xanthogranuloma developing in a patient with diffuse normolipemic plane xanthoma: association of two monoclonal gammopathy‐related disorders
Abstract
clinical events and treatments. OLP is a chronic T-cell-mediated inflammatory disease that affects mucous membranes of the buccal mucosa, palate, gums and tongue. Cytotoxic CD8 + T cells trigger apoptosis of keratinocytes in the oral epithelium. The exact pathogenesis is not fully elucidated. The risk of malignant transformation in patients with the erosive subtype of OLP has been reported as 1.7%. Treatment options for OLP include topical and intralesional corticosteroids and topical calcineurin inhibitors. Severe or persistent disease can be managed with isotretinoin, systemic corticosteroids or other systemic immunosuppressive medications. There are no randomised controlled trials or expert consensus guidelines to guide treatment of OLP. There is limited literature surrounding the use of biologic therapies for lichen planus. Successful treatment of oral and cutaneous lichen planus with adalimumab has previously been reported. Secukinumab and the infliximab biosimilar CT-P13 have been reported to induce lichen planus in patients who are being treated with biologic therapies for psoriasis. Tildrakizumab is a fully humanised monoclonal antibody that inhibits the p19 subunit of IL-23 and is approved by the TGA, Food and Drug Administration and European Medicines Agency for use in patients with moderate-tosevere psoriasis. The IL-23/IL-17 axis plays a key role in the pathogenesis of many chronic inflammatory diseases and overexpression of IL-23 and IL-17 in OLP lesions compared to normal oral mucosal tissue using polymerase chain reaction has been described. The profound clinical response seen in this patient further implicates the IL-23/ IL-17 pathway in the pathogenesis of OLP and suggests that tildrakizumab may be a potential treatment option for OLP, although larger studies are needed to support these findings.