Thatiparthi Akshitha, Martin Amylee, Liu Jeffrey, Wu Jashin J
Ms. Thatiparthi is with Western University of Health Sciences in Pomona, California.
Ms. Martin is with the School of Medicine at University of California in Riverside, California.
J Clin Aesthet Dermatol. 2022 Jun;15(6):68-75.
Phototherapy is a standard treatment for moderate-to-severe psoriasis. However, concern remains regarding the associated cutaneous carcinogenic risk. Our objective is to conduct a systematic review of skin cancer risk for psoriasis patients treated with phototherapy. To achieve our goal, we searched Cochrane, PubMed, and Embase databases. We aimed to evaluate existing literature (from July 1, 2010, to December 31, 2020) on phototherapy for all Fitzpatrick skin phototypes (FSP) which includes 71 articles, and eight articles being categorized in this review. Five studies did not report an increased skin cancer risk with narrowband-ultraviolet blue (UVB) and unspecified UVB for FSP II through VI, with one study not reporting FSP. Three studies did report an increased risk of skin cancer with narrowband-UVB and broadband-UVB for FSP I-VI, with one study also not specifying skin phototypes or UVB phototherapy type. Additionally, a study with psoralen and ultraviolet A with and without narrowband-UVB demonstrated an increased risk of skin cancer in phototypes III and IV. The most commonly reported secondary outcomes with phototherapy were actinic keratosis (123) and solar lentigines (10). Numerous patients were also on additional therapies including methotrexate, acitretin, and biologics. Study limitations include publication bias due to limited number of studies published on this topic in the last ten years along with heterogeneity in reporting. The relationship between phototherapy, psoriasis, and cutaneous oncogenic risk remains contradictory. While phototherapy for psoriasis is an efficacious therapy, further studies are needed to understand the cutaneous oncogenic risk based on FSP to help clinicals tailor treatment recommendations based on skin phototypes.
光疗是中重度银屑病的标准治疗方法。然而，人们对其相关的皮肤致癌风险仍存在担忧。我们的目标是对接受光疗的银屑病患者的皮肤癌风险进行系统评价。为实现这一目标，我们检索了Cochrane、PubMed和Embase数据库。我们旨在评估2010年7月1日至2020年12月31日期间关于所有Fitzpatrick皮肤光型（FSP）光疗的现有文献，共纳入71篇文章，本综述将其中8篇文章进行了分类。5项研究未报告FSP II至VI型使用窄带紫外线蓝光（UVB）和未指明的UVB后皮肤癌风险增加，1项研究未报告FSP情况。3项研究报告了FSP I至VI型使用窄带UVB和宽带UVB后皮肤癌风险增加，1项研究也未指明皮肤光型或UVB光疗类型。此外，一项关于补骨脂素联合紫外线A（有无窄带UVB）的研究表明，III型和IV型光型的皮肤癌风险增加。光疗最常报告的次要结局是光化性角化病（123例）和日光性雀斑（10例）。许多患者还接受了包括甲氨蝶呤、阿维A和生物制剂在内的其他治疗。研究局限性包括由于过去十年中关于该主题发表的研究数量有限导致的发表偏倚以及报告的异质性。光疗、银屑病和皮肤致癌风险之间的关系仍然存在矛盾。虽然银屑病光疗是一种有效的治疗方法，但需要进一步研究以了解基于FSP的皮肤致癌风险，以帮助临床医生根据皮肤光型制定治疗建议。
