Off-label use of biologicals in the management of inflammatory oral mucosal disease

The recent development of novel biologic immunomodulators effective in the treatment of immune-mediated inflammatory conditions has led to their widespread use in rheumatology and dermatology. These include the tumour necrosis factor-alpha antagonists, infliximab, etanercept and adalimumab and the T-cell modulator modifiers efalizumab and alefacept. In dermatology, although these agents are licensed only for psoriasis, increasingly off-label use has extended to a number of conditions in which oral mucosal disease is a significant component. These include Behcet's disease, recurrent apthous stomatitis, benign mucous membrane pemphigoid and lichen planus. This article provides a review of the current literature on such off-label use in oral mucosal disease. J Oral Pathol Med (2008) 37: 575-581