Off-Label Dermatologic Uses of IL-23 Inhibitors

IL-23 inhibitors, such as guselkumab, tildrakizumab, and risankizumab, are primarily approved for psoriasis but show potential for off-label use in treating various inflammatory skin conditions like hidradenitis suppurativa, lichen planus, and frontal fibrosing alopecia. While some case reports and small studies, including one with 69 patients with hidradenitis suppurativa, indicate significant improvements in symptoms and quality of life, the evidence remains limited. Larger, randomized clinical trials are needed to confirm the efficacy and safety of these inhibitors for off-label dermatologic uses. The safety profile is generally favorable, with upper respiratory tract infections being the most common side effect.