Does Psoriasis Increase Your Cancer Risk?
Psoriasis is more than a skin condition: It’s a chronic autoimmune disease that involves systemic inflammation. There’s also evidence that the skin condition may be associated with a higher risk of certain cancers, especially in people who have severe psoriasis or have had the condition for a number of years.
But it’s not clear if the disease itself is actually driving the small increase in cancer risk, or if it’s related to other factors, such as lifestyle choices or even some medications used to manage psoriasis.
Here’s what you need to know about psoriasis and cancer risk, along with expert advice on lifestyle factors, screening recommendations, and treatment options.
Several large studies have explored the link between psoriasis and cancer, and two kinds of cancer have been implicated — squamous cell carcinoma in the skin and lymphoma, says Robert T. Brodell, MD, a professor of dermatology at the University of Mississippi Medical Center in Jackson.
Although these types of studies can be informative, they show an association, not causation, and some relationships show up simply by chance, Brodell says. Still, people with psoriasis have been shown to have an increased risk for squamous cell cancer in most of these kinds of studies.
But it may not be the psoriasis or the inflammation that comes with it causing the increased risk.
“Almost all patients with psoriasis come to find out that exposure to the sun and ‘tanning’ help to control their psoriasis, and there is no question that sun exposure increases the risk of skin cancer, including squamous cell carcinoma,” says Brodell.
People with psoriasis who have spent more time in the sun may have increased rates of skin cancer for this reason, he adds.
Evidence suggests that psoriasis may be associated with a higher risk of lymphoma, a cancer of the immune system, says Joel M. Gelfand, MD, a professor of dermatology and of epidemiology at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia.
Cutaneous T-cell lymphoma is a rare type of cancer that begins in white blood cells known as T cells or T lymphocytes. These cells help the body's germ-fighting immune system, but in cutaneous T-cell lymphoma, the T cells attack the skin.
“If psoriasis is not responding appropriately to treatment, then a simple skin biopsy may be necessary. Additional symptoms of lymphoma include swollen glands, weight loss, fatigue, and night sweats,” says Gelfand.
Patients with these symptoms, particularly if they are persistent for weeks or months should see their medical provider, he says.
The good news? Most cancer risks associated with psoriasis are low and highly manageable. Here's how to stay proactive.
The slight increase risk in skin cancer doesn’t mean you have to avoid the sun completely, but you do need to take precautions (just like people without psoriasis) including:
If you’ve had light therapy (phototherapy), use biologic medications, or spend a lot of time in the sun to ease your symptoms, it’s important to talk to your doctor about skin cancer screening.
“Patients with psoriasis, especially those who receive light treatment, get a lot of natural tanning sunlight, or take certain injectable biologic medications (anti-TNF drugs), should have their dermatologist check them annually,” says Brodell.
“Tell your doctor if you see a skin lesion that is growing or changing or an ulceration that will not heal,” says Brodell. Do it right away; don’t wait until your annual appointment to get it checked out.
Gelfand recommends the following lifestyle choices to lower your risk of cancer.
It’s also important to take your psoriasis medications as directed by your doctor, says Gelfand. “Most treatments for psoriasis do not seem to impact cancer risk,” he says.
Although there is some evidence that biologics that target TNF may increase the risk of lymphoma and possibly melanoma, those cases are very rare, he says.
“Our most targeted treatments such as biologics that block IL17 or IL23 do not appear to confer any risk of cancer and are often used in patients with a history of cancer,” says Gelfand.
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