CyA in Psoriasis

Since the serendipity which led to the discovery of a possible efficacy of CyA in the treatment of psoriasis [77], a great number of studies on patients with different forms of psoriasis, including psoriasic arthritis, have definitively ratified its effectiveness [78, 79], The Sandoz Pharma clinical study programme conducted until 1990 on 842 psoriasic patients treated with CyA disclosed the development of 17 cases of malignancy: 6 malignant or pre-malignant skin lesions, 6 solid organ tumors, and 5 lymphoproliferative disorders (3 benign cutaneous lymphoproliferative infiltrations, 1 B-cell lymphoma, which regressed after CyA discontinuation, 1 T-cell lymphoma) [80], Psoriasis patients developing skin malignancies during the use of CyA in general had been previously treated with PUVA and/or methotrexate [81-83], and it is difficult to determine whether the incidence of skin cancers (estimated as 0.5-0.8/1000 patients per month) is specific to CyA or to previous PUVA therapy, or both [84]. It should be borne in mind that, even if psoriasis can severely affect the quality of life, it is not a life-threatening disease and, therefore, the risk/benefit ratio of immunosuppressive treatment should be carefully evaluated. Patients with previous or concomitant malignancy should not be considered for CyA therapy. Patients treated with CyA should not, as far as possible, receive concomitant immunosuppressive drugs or radiation therapy, including PUVA and UVL; moreover, they should be made aware of the higher risk of overexposure to sunlight [85], Whenever atypical lesions are seen, whether before or during CyA treatment, a prompt biopsy of the lesion should be performed. Grossman et al. [86] suggested that all female patients should undergo a gynecological examination with a Papanicolau smear before beginning CyA and every 6 months thereafter. The authors advocate that the presence of human papilloma virus infection should be a relative contraindication to CyA treatment.

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