Psoriasis treatment may up cancer risk
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Patients with moderate to severe psoriasis may need life-long treatment with a variety of therapies to relieve symptoms of the scaly skin condition and research has shown that both traditional and newer therapies for psoriasis can increase patients’ risk of certain cancers.
Long-term treatment with so-called PUVA therapy, they note, is associated with increased risks of deadly malignant melanoma as well as a less deadly non-melanoma skin cancer called cutaneous squamous cell carcinoma, Dr. Jeffrey M. Weinberg, of St. Luke’s-Roosevelt Hospital Center, New York, and colleagues note in the Journal of the American Academy of Dermatology.
During PUVA therapy, patients are given the photosensitizing drug psoralen and exposed to ultraviolet A light.
Treatment with ultraviolet B (UVB) radiation does not appear to increase melanoma or non-melanoma skin cancer risk, the researchers report.
Taking the drugs methotrexate, cyclosporine or mycophenolate mofetil, Weinberg and colleagues note, have been linked with increased risks of “lymphoproliferative” disorders in trials involving patients with rheumatoid arthritis and in psoriasis case reports. Lymphoproliferative disorders involve increased production of lymphocytes, which is normally seen as a response to infection.
While the risk of malignancy with the newer “biologic” therapies remains unclear, studies suggest that so called “TNF blockers” may cause a slightly increased risk of cancer, including non-melanoma skin cancer and blood cancers. The newer biologics include infliximab (Remicade), etanercept (Enbrel) and adalimumab (Humira).
The reviewers call for further studies to clarify the “potentially serious relationship” between psoriasis treatments and malignancies.
In the meantime, they say psoriasis patients should have a “thorough” cancer history, family history, skin exam, and, “especially,” blood tests attempting to identify any blood abnormalities before starting on either the newer biologics or the more traditional psoriasis therapies.
SOURCE: Journal of the American Academy of Dermatology, June 2009.
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