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Malignancy Risks Higher In Patients With Severe Psoriasis

Patients with severe psoriasis are at increased risk of developing a malignancy, especially non-melanoma skin cancers and lymphoma.

North American researchers report that they have demonstrated that "individuals with psoriasis requiring treatment with systemic agents are almost twice as likely, after accounting for the effects of age and sex, to develop a malignancy than are individuals with hypertension."

They compared the risk of malignancy for individuals with psoriasis of varying severity with patients who had severe eczema, those who had had organ transplants and hypertension patients placed in a reference group.

"Magnitude of the increased risk in individuals with severe psoriasis is similar to that in patients with organ transplants," the investigators note.

"However, individuals with psoriasis who do not require treatment with systemic agents seem to have the same risk of malignancy as individuals with severe eczema, which may be equal to or slightly greater than our reference group."

Researchers from the University of Pennsylvania School of Medicine in Philadelphia point out that psoriasis affects approximately 1 percent to 2 percent of the US population. It can cause severe morbidity and psychological distress.

"Most patients with psoriasis are treated with topical agents, which are believed to have few systemic effects.

"However, patients with severe disease are often treated with potent systemic agents, some of which have been associated with increasing an individual's risk of developing a malignancy."

Investigators used claims databases covering 259,808 Medicaid patients from three US states in their risk comparison. They observed 1,101 patients with severe psoriasis and 16,519 people with less severe psoriasis. Observation periods averaged more than two years.

They note that all individuals in the study were part of the US Medicaid population. This helped investigators avoid ascertainment bias and to control, at least in part, for socio-economic status.

"We believe that the hypertension group is likely to reflect the true population rate of developing a malignancy in our Medicaid population," the researchers suggest.

They also estimated the malignancy risk in organ transplant patients "to obtain a benchmark for rates that are likely to be associated with the use of immunosuppressive medications, many of which are used or might be used in the future to treat psoriasis."
Archives of Dermatology, 2001; 137: 778-783. "The Risk of Malignancy Associated With Psoriasis"

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