SDEF: Psoriasis Comorbidities Carry Implications for Disease Management

As for cancer, it is a concern in psoriasis patients because of the chronic use of immunosuppressive therapies, comorbid behaviors, and chronic inflammation, Dr. Gelfand said. Patients with severe psoriasis are 41% more likely to die of cancer than are those without psoriasis.

Studies have shown – although not consistently – that psoriasis may be linked with lung, liver, pancreatic, breast, colon, bladder, and kidney cancer. Lymphoma is also a particular concern, with cutaneous T-cell lymphoma having the strongest association.

As with cardiovascular disease, however, findings are not strong or consistent enough to confirm a causal effect of psoriasis on cancer risk, or to clarify whether any association is a disease effect or treatment effect.

Still, the available findings are concerning enough that biopsy should be considered in severe disease, especially if clinical features are not classic, and in those who fail to respond to treatment, because cutaneous T-cell lymphoma may progress rapidly in those on immunosuppressive therapy.

"Always consider a skin biopsy in patients with atypical features of psoriasis and those not responding to treatment," Dr. Gelfand said.

Also, encourage patients to stay up to date on age-appropriate cancer screening. According to Centers for Disease Control guidelines, women aged 21-70 years should undergo cervical cancer screening every 2-3 years, women aged 50-74 years should undergo screening for breast cancer by mammography every 2 years, and men and women aged 50-75 years should undergo screening for colon cancer by fecal occult blood testing every year, by flexible sigmoidoscopy every 5 years, and by colonoscopy every 10 years, he said.

Dr. Gelfand has been an investigator and/or consultant for Amgen, Abbott, Centocor, Pfizer, Celgene, Novartis, and Genentech. He reported having no relevant financial disclosures. SDEF and this news organization are owned by Elsevier.