Can Psoriasis Cause Cancer? A Closer Look

Psoriasis is a skin disease that can cause inflamed patches on the skin. Psoriatic arthritis is another form of the disease that can lead to pain and stiffness in the joints. Cancer is a broad term that refers to any type of cancerous growth. Some studies have shown that people with psoriasis are at an increased risk for developing certain types of cancer, such as skin cancer, esophageal cancer, liver cancer, pancreatic cancer, etc. There’s not enough information available to say for sure whether psoriasis causes cancer or vice versa, but thre are studies show the link between psoriasis and cancer. It’s important to talk to your doctor if you have psoriasis and you’re concerned about your health.

Psoriasis is a noncontagious chronic skin disease, which is also an autoimmune disorder. It is commonly seen as skin lesions, plaques, scales, itch, and redness. There are various forms of psoriasis affecting various parts of the body. The prevalence of psoriasis in our country lies between 0.44 to 2.2 percent. It is more common in middle-aged adults. Clinically psoriasis is pustular and nonpustular, however, any forms are classified further. Psoriasis is chronic and without a gold-standard cure. However various treatment therapies can ease the severity of the disease and its symptoms. 

Cancer is a major cause of mortality and morbidity worldwide. It ranks first or second as a reason for premature deaths. The projected cancer burden in India in 2021 was 26.7 million and is expected to reach 29.8 million by 2025. The highest burden of cancers is in the north and northeast regions. Males have more prevalence than females. Lung and breast cancer stand high in prevalence with a 10 percent rate while the cancer of the cervix uteri stands at least at 4 percent. Cancers of the esophagus, mouth, and stomach have a prevalence of 5.8, 5.7, and 5.2 percent each. Contrary to the belief that liver cancer is the most dominant, its preponderance is around 4 percent. 

Association between psoriasis and cancers

People with severe forms of psoriasis have 22 percent of getting cancer as per the studies. If broken into different forms of cancers, severe psoriasis has been linked to more than 11 times higher risks for squamous cell carcinoma which is the most common form of skin cancer. There is a double risk for esophageal cancer. Having severe psoriasis also showed a double risk for liver cancer. However, the risk of developing pancreatic cancer is 45 percent in patients with psoriasis. The list does not end here. People having psoriasis are also at an exposed risk for colorectal cancer, non-Hodgkin’s lymphoma, and cancers in the kidney. 

There are many theories put forth to explain the relationship between psoriasis and developing cancers. Psoriasis causes chronic inflammation in the body, which directly points to cancer according to a theory. Second, it is believed that the treatment options used in treating psoriasis trigger the cancers in the body. Phototherapy and immunosuppressants utilized in the treatment have recorded such lethal effects. Thirdly, the addictions in the psoriasis patients like smoking, drinking, etc which caused the disease are also possible triggering factors for the cancers to develop.

• There were a lot of cohort studies that closely studied the relationship between psoriasis and the prevalence of cancers in psoriasis patients. The results proved the expectancy. The risks for nonmelanoma skin cancers and lymphoma are higher in patients who were given phototherapy and systemic therapy to treat their symptoms. 
• The risks for nonmelanoma skin cancers are drawn out to be a moderate to severe psoriasis disease, exposure to phototherapy especially psoralen and ultraviolet A which is also called PUVA, and utilization of systemic medications. 
• In the case of lymphomas, including cutaneous t-cell lymphoma, the increased risk depends on the severity scale of psoriasis. In moderate to severe psoriasis, the risk factor is 1.89, while in mild psoriasis the risk for lymphoma is 1.34, and overall the risk associated with psoriasis for lymphomas is 1.31.
• The risks for colon cancer, solid organ malignant neoplasms, breast cancer, and prostate cancer were not any higher than in controls who are healthy. 
• Patients with heavy smoking habits alongside those living with moderate to severe psoriasis have a 60 percent increased risk for lung cancer than patients without. 
• The association between psoriasis and melanoma and pancreatic cancer is not directed through these studies. But the probability of developing melanoma is much lower in psoriasis patients than in nondermatological patients.  
• Chronic systemic inflammation which is seen in psoriasis is also a potential risk for pancreatic cancer. The chronic alcohol consumption seen in these very patients is also a contributing factor to chronic pancreatitis
• Further Along, patients with cutaneous t-cell lymphoma are misdiagnosed to be psoriasis sometimes due to the positive association between them.
• Biologics treatments in psoriasis therapy have revolutionized disease management. There are four types of biologics, tumor necrosis factor inhibitors, interleukins antagonists, and inhibitors. There are mixed outcomes from various studies. The use of etanercept, infliximab, and adalimumab from the tumor necrosis factor inhibitors has not shown any risks of cancers when used in psoriasis therapy but in rheumatoid arthritis and Crohn’s disease. Other data show that the utilization of tumor necrosis factor (TNF) inhibitors therapy in psoriasis has reported higher risks for nonmelanoma skin cancers.
• Although studies regarding melanoma are scarce, biologics treatment heightened the risks for melanoma in psoriasis patients.
• In oral treatments, methotrexate is the commonly prescribed drug and the risk of developing skin cancers associated with it is uncertain. However, the risks for nonmelanoma skin cancers are increased in patients treated with both psoralen ultraviolet A and methotrexate. 
• Cyclosporine when used as an immunosuppressant in organ transplant acts as a risk of cancer, however, in psoriasis patients, it is not. It is because it is utilized in very small doses in psoriasis therapy. But similarly to methotrexate, a combination of cyclosporine with that PUVA has increased the risk for nonmelanoma skin cancers.
• Skin cancers are the most investigated type of cancer because of the treatments with ultraviolets in phototherapy. Ultraviolet B is a well-proven carcinogen. The patients treated with these rays develop cancers in a dose-dependent manner, melanocytic proliferations, and mutations. 
• Additionally, most psoriasis patients improve their skin during summer. This sun-seeking behavior and home UVB treatments raise the risk for nonmelanoma skin cancers. 
• The use of topical creams and corticosteroids has shown no threat to cancers as they have a high safety profile. Also, there are mixed conceptions of oral glucocorticoids association with cancers.

How to reduce the risk of cancers in psoriasis?

As the incidence of drugs and medications is one of the backed-up reasons for the development of cancers, a deeper and more practical study in real life is necessary for every drug prescribed. 

A few changes in lifestyle such as exercise, eating healthy, addiction-free lifestyle, weight loss, maintaining a healthy weight and BMI, checking on comorbidities, etc. are more doable steps for a risk-free life. 

NOTE:
“This article does not provide medical advice. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on this website. If you think you may have a medical emergency, immediately call or visit your doctor.”
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References

1. https://openventio.org/wp-content/uploads/Clinical-Descriptive-Study-of-Psoriasis-in-India-Triggers-Morbidities-and-Coincidences-DRMTOJ-6-144.pdf
2. https://www.health.com/condition/psoriasis/psoriasis-cancer-link
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5273859/
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8538945/
5. https://bmccancer.biomedcentral.com/articles/10.1186/s12885-022-09578-1
6. http://www.healio.com/dermatology/psoriasis/news/online/%7B820d3cd1-4b5d-467d-9960-0be375d316fe%7D/slight-risk-of-cancer-associated-with-psoriasis
7. Chiesa Fuxench ZC, et al. JAMA Dermatol. doi:10.1001/jamadermatol.2015.4847.