Severe Psoriasis Linked To Higher Risk Of Death From Liver Esophageal Pancreatic Cancers
Patients with severe psoriasis have an increased risk of dying from liver, esophageal, and pancreatic cancers, and people with psoriasis have an overall increased risk of a variety of other cancers, according to a meta-analysis and review published Wednesday in JAMA Dermatology.
Patients with severe psoriasis have an increased risk of dying from liver, esophageal, and pancreatic cancers, and people with psoriasis have an overall increased risk of a variety of other cancers, according to a meta-analysis and review published Wednesday in JAMA Dermatology.
The authors said the findings indicate that dermatologists and psoriasis guidelines should pay more attention to the notion of cancer as a comorbidity of psoriasis, in the same way that cardiovascular, psoriatic arthritis, and other diseases are viewed.
This is the first meta-analysis of the mortality risk of cancer for these patients the study also attempted to stratify the risk by psoriasis severity. While psoriasis severity is typically measured through Psoriasis Area and Severity Index improvement scores, obtaining that information was not possible in this review of 58 unique observational studies from 6 databases. Instead, the researchers used other measures as proxies, such as types of treatment and whether or not the patient had been hospitalized.
Overall cancer mortality risk was highest in patients with severe psoriasis , specifically:
- Liver cancer
- Esophageal cancer
- Pancreatic cancer
Reference
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Is Your Stomach to Blame?
Who would have thought that a severe psoriasis outbreak could start because of something going wrong inside of your stomach and intestines? Yet, new research developed by psoriasis expert Edgard Cayce shows a distinct link between a leaky gut and a scaly psoriatic episode. According to Cayce, the primary source of psoriasis can be found in the intestinal tract, where toxins are leached into the body. This causes the immune system to react by thickening the skin. At the same time, the skin tries to purge the toxins through its layers, which can cause scabs and sores to form.
Could Arthritis Be the Cuplrit?
The intestines arent the only link to psoriasis found by researchers arthritis seems to also contribute to it. As many as one-third of all psoriasis patients eventually develop some form of psoriatic arthritis. Unlike normal forms of arthritis, those with psoriatic arthritis do not exhibit a rheumatoid factor when their blood is tested. This indicates that the arthritic condition comes solely from either the psoriasis itself or the underlying cause of the skin affliction.
Could a Virus Be the Cause?
Arthritis has been linked to certain virus and so have other auto-immune disorders. This leads some researchers to think that psoriasis too may start with a virus, which is what kicks the immune system into overdrive.
Many Forms Many Treatments
What does one of these AKs look like? Well, a lot of different things.
They vary widely, Dr. Hall says. They could be thick, red, scaly patches or they could be little what we call keratotic nodules. They could be red bumps with a tan crust or could present with a raised little horn-shaped part, called a cutaneous horn.
Dr. Hall says to pay attention to anything that keeps coming back or doesnt heal, just as you would while examining your skin for signs of fully formed skin cancers.
I tell my patients that if they have any area like that, to call and we can get them in right away. That way we can treat them early and prevent squamous cell carcinoma formation.
Treatment options for AKs run the gamut: Dr. Hall says she usually begins treatment with cryosurgery, but depending on a patients preferences and responsiveness, there are plenty of alternatives. Doctors and patients can also decide between laser surgery, curettage and desiccation, chemical peels and topical treatments.
We can do combinations of treatments as well, Dr. Hall says, based on the areas of involvement and how many you have.
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Tips For Getting The Right Diagnosis
For the best chance of getting the right diagnosis, a person should make sure they give an accurate history when a doctor or dermatologist asks. The more information a medical professional has to work with, the more likely they are to diagnose a persons illness correctly.
This is especially important with skin conditions such as psoriasis. A medical professional will typically rely on both a history and a visual assessment to work out what a persons skin condition is. A visual assessment alone may not be enough.
If a person is unsure about their diagnosis, they can request further diagnostic tests. This may involve speaking to a dermatologist, who might use dermoscopy or recommend a skin biopsy.
A skin biopsy involves taking a small sample of the skin and sending it to a lab for testing.
Looking After Your Skin After Treatment
After treatment, you may need follow-up appointments with your dermatologist or GP to see if you need any further treatment.
If you had surgery, you may need to have any stitches removed at your GP surgery a few weeks later.
After treatment:
- see a GP if an existing patch starts to bleed, change in appearance or develops a lump do not wait for your follow-up appointment
- see a GP if you notice any worrying new patches on your skin
- make sure you protect your skin from the sun wear protective clothing and use a sunscreen with a high sun protection factor of at least 30
Page last reviewed: 21 May 2019 Next review due: 21 May 2022
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Can Skin Cancer Look Like Psoriasis
Psoriasis and skin cancers are two distinct conditions, both with multiple types. However, some forms of skin cancer may produce visible symptoms similar to certain types of psoriasis.
It is important for a person to talk with their doctor if they notice any sudden changes in their skin.
Learn more about the different types of psoriasis here.
Causes Of Bowen’s Disease
Bowen’s disease usually affects older people in their 60s and 70s.
The exact cause is unclear, but it’s been closely linked with:
- long-term exposure to the sun or use of sunbeds especially in people with fair skin
- having a weak immune system for example, it’s more common in people taking medicine to suppress their immune system after an organ transplant, or those with AIDS
- previously having radiotherapy treatment
- the human papillomavirus a common virus that often affects the genital area and can cause genital warts
Bowen’s disease does not run in families and it’s not infectious.
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Characteristics Of The Studies Included
The original electronic search yielded 1762 papers potentially relevant for this review . After removing duplicates, 1549 were initially screened. Of these, 1467 were excluded after the screening of study titles and abstracts. The remaining 82 studies were retrieved for more detailed evaluation and 10 of them met the review inclusion criteria. The main characteristics of the included studies are reported in Table 1. Most of the included studies were prospective cohort studies , three were retrospective cohort studies, one was a nested case-control study and one was a study comparing clinical trials data and real-world data .
Figure 1 PRISMA flow-chart showing the process of literature search and study selection.
Table 1 Characteristics of the studies included in the systematic review.
All included studies focused on the incidence of skin malignancies in patients treated with TNF- inhibitors, three of them included also patients treated with ustekinumab and only one study reported NMSC IRs also for apremilast and tofacitinib . No observational studies assessing the incidence of skin cancer in patients with inflammatory cutaneous diseases and treated with secukinumab, ixekizumab, brodalumab, tildrakizumab or risankizumab were found. All the included studies used real-world data sources, such as drug or disease registries and claims databases.
Of the 10 studies included in this systematic review, 7 provided data suitable for meta-analysis.
What Happens If Actinic Keratosis Is Left Untreated
Actinic keratosis is counted as a precancerous condition, and it can indeed develop into a type of skin cancer if left untreated or unchecked over the years. Somewhere between 5-10% of actinic keratoses turn into cutaneous squamous cell carcinoma , which is one of the most common skin cancers. CSCC is characterised by the abnormal overgrowth of skin cells, and can be disfiguring or fatal if not treated.
Luckily, actinic keratosis doesnt turn into melanoma, a different kind of skin cancer which is more deadly than cSCC, although those who are at risk for AK are also at higher risk for melanoma. Thats because the same factors – sun exposure over years, easily burnt, fair-skinned etc – apply to both conditions.
Its very important to get any skin changes checked out early, especially if youre over 40 and fit into the at risk demographic. Both precancerous skin cell changes and skin cancer lesions themselves can vary hugely in appearance, so it is not easy to warn against any particular kind of blemish or spot. Instead, take notice of any change in texture, colour and sensation, especially lesions or blemishes that keep coming back in the same place, or which dont get better.
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Protection Of Study Subjects
This study was developed in accordance with the STROBE guidelines and was approved by the institutional review board of the University of Pennsylvania and by the Scientific Review Committee of CSD Medical Research, United Kingdom. This study was a population-based study using data already collected for these purposes. Data were collected by a third party and deidentified before they were made available for research purposes. Because our study analyzed data already collected for these purposes, patient consent was not required.
The Similarities Between Psoriasis And Some Forms Of Skin Cancer
A few similarities can exist between psoriasis and some forms of skin cancer, which means it can seem hard to diagnose the problem if you dont quite know what you are looking for. A few of the similarities include:
- Potential changes in the texture or apparent thickness of the skin
- Changes in the color of the skin
- Possible raised or sunken areas of skin with scaly spots
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How To Tell The Difference Between Psoriasis And Skin Cancer
One significant factor to consider with psoriasis and skin cancer is your age. Psoriasis is more likely to affect people who are between the ages of 15 and 35. Even though skin cancer can be diagnosed at any age, it is far more common in older adults than young adults.
Look at where the skin issue is located. Skin cancer most often develops on the body where the sunlight usually hits, such as on the face, arms, upper chest, neck, or legs. Psoriasis is more likely to be found around the joints, such as on your knees or elbows or at the bends of these joints. Psoriasis is also more common on the scalp. Skin cancer on the scalp is not quite so common because the hair protects the scalp from the sun.
A few other noteworthy differences:
- Skin cancer is less likely to itch or bleed than psoriasis unless the tumor has grown quite large
- Skin cancer can take on various colors depending on the type, such as brown, red, or blue psoriasis is more likely to generate only red or pinkish spots
- Psoriasis can be linked to other health conditions, such as diseases that affect the immune system skin cancer is more relative to skin type and tone, genetics, and UV exposure
What Is The Treatment For Squamous Cell Cancer
Treatment for squamous cell cancer may include one or more of the following:
- Surgery
- Excision: removes the entire tumor
- Curettage and electrodesiccation: cancer is removed by scraping it with a long, thin instrument with a sharp looped edge on one end and the area is treated with an electric needle to destroy any remaining cancer cells
- Mohs surgery : removes one layer of skin at a time, samples are checked for cancer, and the process is repeated until there are no cancer cells in the skin sample. Process can be slow but can leave more tissue intact.
- Lymph node surgery
- Lymph node dissection: many nodes are removed
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No Higher Risk Of Cancer For Patients With Psoriasis Treated With Biologics Analysis Finds
The review found no increased risk of cancer when looking at both keratinocyte cancer and lymphomas in patients on biologics vs conventional therapy. Overall, however, patients with psoriasis appear to have a slightly increased risk of certain cancers.
A new meta-analysis and review of the risk of cancer in patients with psoriasis found no increased risk found for those treated with biologics. Overall, however, patients appear to have a slightly increased risk of cancer, particularly keratinocyte cancer and lymphomas.
The systematic review and meta-analysis, published in JAMA Dermatology Wednesday, consisted of 112 studies incolving over 2 million patients. Overall, the review found that the prevalence of cancer in patients with psoriasis was 4.78% , with an incidence rate of 11.75 per 1000 person-years and a risk ratio of 1.21.
As with a similar meta-analysis published in 2013, this review showed a similar link between psoriasis and cancer. The 2013 study found an association between psoriasis and cancer excluding keratinocyte cancer, keratinocyte cancer, and some solid cancers, including respiratory tract and urinary tract cancer. Besides the link with skin-related cancer, the current study found a link with bladder cancer and lung cancer. The authors noted that their analysis is larger, with twice as many studies and newer trials.
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Is Your Stomach to Blame?
Who would have thought that a severe psoriasis outbreak could start because of something going wrong inside of your stomach and intestines? Yet, new research developed by psoriasis expert Edgard Cayce shows a distinct link between a leaky gut and a scaly psoriatic episode. According to Cayce, the primary source of psoriasis can be found in the intestinal tract, where toxins are leached into the body. This causes the immune system to react by thickening the skin. At the same time, the skin tries to purge the toxins through its layers, which can cause scabs and sores to form.
Could Arthritis Be the Cuplrit?
The intestines arent the only link to psoriasis found by researchers arthritis seems to also contribute to it. As many as one-third of all psoriasis patients eventually develop some form of psoriatic arthritis. Unlike normal forms of arthritis, those with psoriatic arthritis do not exhibit a rheumatoid factor when their blood is tested. This indicates that the arthritic condition comes solely from either the psoriasis itself or the underlying cause of the skin affliction.
Could a Virus Be the Cause?
Arthritis has been linked to certain virus and so have other auto-immune disorders. This leads some researchers to think that psoriasis too may start with a virus, which is what kicks the immune system into overdrive.
Recommended Reading: Does Sweating Make Psoriasis Worse
Who Gets Psoriasis That Affect The Joints
Years after developing psoriasis on their skin, some people get a type of arthritis called psoriatic arthritis, which affects the joints. Its also possible to develop psoriatic arthritis before getting psoriasis on your skin.
Its not possible to predict who will get psoriatic arthritis. For this reason, its important for people who have psoriasis to pay attention to their joints.
Without treatment, psoriatic arthritis can worsen and damage joints. This damage is irreversible and can cause a lifelong disability. Treatment can prevent psoriatic arthritis from worsening.
Early warning signs of psoriatic arthritis include:
-
A swollen and tender joint, especially within a finger or toe
-
Heel pain
-
Swelling on the back of your leg, just above your heel
-
Stiffness in the morning that fades during the day
Actinic Keratosis On An Arm
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Actinic keratosis, also called solar keratosis, is usually caused by too much sun exposure. It can also be caused by other factors such as radiation or arsenic exposure.
They appear predominantly on sun-exposed areas of the skin such as the face, neck, back of the hands and forearms, upper chest, and upper back. You can also develop keratoses along the rim of your ear.
In pictures of actinic keratosis, you’ll see they are typically pink, scaly, and flat. It’s also common to have harmless brown spots or “liver spots.”
Actinic keratosis is caused by cumulative skin damage from repeated exposure to ultraviolet light, including that found in sunshine. Sometimes actinic keratoses can develop into an invasive and potentially disfiguring skin cancer called squamous cell carcinoma.
Most actinic keratoses are not premalignant. Only about 10% will become squamous cell carcinomas.
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What Is The Evidence
Bard, S, Torchia, D, Schachner, LA. Managing pediatric patients with psoriasis. Am J Clin Dermatol. vol. 11. 2010. pp. 15-7.
Silverberg, NB. Update on pediatric psoriasis, part 1: clinical features and demographics. Cutis. vol. 86. 2010. pp. 118-24.
Silverberg, NB. Update on pediatric psoriasis, part 2: therapeutic management. Cutis. vol. 86. 2010. pp. 172-6.
Ståhle, M, Atakan, N, Boehncke, WH. Juvenile psoriasis and its clinical management: a European expert group consensus. J Dtsch Dermatol Ges. vol. 8. 2010. pp. 812-8.
De Jager, ME, de Jong, EM, van de Kerkhof, PC, Seyger, MM. Efficacy and safety of treatments for childhood psoriasis: a systematic literature review. J Am Acad Dermatol. vol. 62. 2010. pp. 1013-30.
Lara-Corrales, I, Xi, N, Pope, E. Childhood psoriasis treatment: evidence published over the last 5 years. Rev Recent Clin Trials. vol. 6. 2011. pp. 36-43.