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Friday, 28 September, 2001, 23:24 GMT 00:24 UK
Psoriasis drug 'cancer risk'
Michael Gambon's character in the Singing Detective suffered from psoriasis
Michael Gambon's character in the Singing Detective suffered from psoriasis
Patients with the skin condition psoriasis are at increased risk of cancer if they have a particular combination of treatment, scientists have said.

Those at risk of developing skin cancer were treated with the drug ciclosporin, and photochemotherapy.

Ciclosporin is an immunosuppressant. Previous research has shown such agents are linked to an increased risk of skin cancer in patients who have had organ transplants.

The photochemotherapy treatment was developed in the early 1970s, using the light sensitive drug psoralen and ultraviolet A radiation (PUVA). It is now known to be cancer causing.


This confirms the need for thorough and ongoing research into medication used for severe psoriasis and its side effects

Gladys Edwards, Psoriasis Association
Psoriasis causes the skin to become very inflamed, producing red, thickened areas with silvery scales, mainly on the scalp, elbows, knees and lower back.

In a paper in The Lancet, researchers from the Beth Israel Deaconess Medical Center, Boston write: "In view of the magnitude of risk we recorded with restricted use of ciclosporin, we believe it prudent to assess carefully the carcinogenic potential of other immunosuppressive treatments for patients with severe psoriasis.

"Only then can the long-term safety of these agents for this chronic disease be established."

UK researchers said it was important psoriasis sufferers knew as much as possible about their treatments.

Analysis

The US researchers looked at the risk of developing squamous cell cancer of the skin, the most curable form of the disease, in patients who had been exposed to PUVA and other treatments for severe psoriasis.

They looked at 28 patients who had previously taken part in a PUVA study in the mid 1970s, and who were taking ciclosporin.

All 1,380 patients who had taken part in the original study were also assessed, to help clarify the relation between ciclosporin and the frequency of that kind of cancer.

In the five years prior to starting on ciclosporin, six of the 28 (21%) developed a total of 20 squamous cell cancers.

After starting on the drug patients were followed up for an average of six years.

Thirteen (46%) developed a total of 169 squamous-cell carcinomas.

After adjusting for how much exposure patients had to PUVA and methotrexate, another psoriasis treatment, incidence of tumours was seven times higher after first ciclosporin use than in the previous five years.

But any use of ciclosporin was linked to a three-fold increase in risk of skin cancer, and use for at least three months was associated with a nearly four-fold increase.

Patients were at "substantially greater risk" if they had taken ciclosporin for three months or more than if they were exposed to at least 200 PUVA treatments.

'Inform patients'

Gladys Edwards, chief executive of the Psoriasis Association said a review of treatments for severe psoriasis published last year was clear that the combination of PUVA and ciclosporin was not recommended.

"This research confirms the need for thorough and ongoing research into medication used for severe psoriasis and its side effects.

"The Psoriasis Association believes that it is important for patients to be well informed about the medication they are prescribed.

"They are then in a position to make educated choices about their treatment programme, in partnership with their doctors, weighing up the proven efficacy of medication against possible short term and long term side effects.

"Patients who have concerns after reading about this research should, of course, talk to their GP or consultant."

See also:

08 Jun 01 | Health
Fresh treatment for skin misery
11 Jan 01 | Health
Vaccine 'switches off' psoriasis
02 Aug 00 | Health
Skin drug helps smokers
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