Poster Presentation Australasian Society for Dermatology Research Annual Scientific Meeting 2024

Cervical intraepithelial neoplasia whilst on Ustekinumab for chronic plaque psoriasis (#60)

Natasha Abeysekera 1 , Lena von Schuckmann 1 2 3
  1. Dermatology, Sunshine Coast University Hospital, Birtinya, QLD, Australia
  2. Dermatology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
  3. Frazer Institute, University of Queensland, Woolloongabba, QLD, Australia

Introduction:

Severe psoriasis is commonly treated with biologic medications which block IL-23 or IL-17. There is evidence suggesting that these biological pathways are relevant to HPV infections and their clearance. Studies suggest HPV infections induce excess IL-17 which is thought to suppress the body’s immune response to HPV. It is therefore hypothesised that IL-17 inhibition may allow a greater immune response to and clearance of HPV. Conversely, animal studies suggest that IL-23 may play an important role in preventing the progression of premalignant lesions to cancer.  

We describe a case report of a patient with severe plaque psoriasis who was switched from an IL-23 blocker to an IL-17 blocker after being diagnosed with CIN associated with HPV.  

Case 

A 38-year-old woman has been managed since 2015 for severe chronic plaque psoriasis with Ustekinumab (IL-23 blocker).

In May 2023, the patient’s psoriasis was no longer adequately controlled with Ustekinumab. She was also noted to have a positive cervical screening test in April 2022 with HPV-18 and other genotypes identified. This patient had not previously received vaccination against HPV. The histopathology from large loop excision of the transformation zone confirmed high grade squamous intraepithelial lesion without evidence of invasive malignancy.

Given the research findings described above and her poor disease control, the decision was made to change the patient from Ustekinumab (IL-23 blocker) to Secukinumab (IL-17 blocker). On repeat cervical smear test in April 2024, there was no evidence of squamous intraepithelial lesion nor HPV.

Conclusion

Preliminary research suggests that IL-17 and IL-23 pathways may be important for cervical HPV clearance and CIN development. We present a case who cleared cervical HPV after switching from an IL-23 to an IL-17 for treatment of her psoriasis. Further research is required to investigate, understand and verify these effects in more detail.  

  1. Caughron B, Yang Y, Young MRI. Role of IL-23 signaling in the progression of premalignant oral lesions to cancer. PLoS One 2018;13(4):e0196034.
  2. Young MR, Levingston CA, Johnson SD. Treatment to sustain a Th17-type phenotype to prevent skewing toward Treg and to limit premalignant lesion progression to cancer. Int J Cancer 2016;138(10):2487-98.
  3. Petrini CG, Bastos LB, Duarte G, Dos Santos Melli PP, Alves-Filho JC, Quintana SM. Downregulation of IL-2 and IL-23 in Cervical Biopsies of Cervical Intraepithelial Lesions: A Cross-Sectional Study. Acta Cytol 2020;64(5):442-51.
  4. Gosmann C, Mattarollo SR, Bridge JA, Frazer IH, Blumenthal A. IL-17 suppresses immune effector functions in human papillomavirus-associated epithelial hyperplasia. J Immunol 2014;193(5):2248-57.
  5. Chiu HY, Tsai TF. The impact of secukinumab treatment on the prevalence of human papillomavirus in patients with psoriasis: A pilot study. J Am Acad Dermatol 2016;75(1):224-6.