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Immunosuppressive Safety Data of Cyclosporine Use in Psoriasis Patients

Cyclosporine is an immunosuppressive agent that has been traditionally used in organ transplant patients. Although it has been used with success in psoriasis patients, its serious side effects in the transplant population have hindered many dermatologists from exploiting its therapeutic capabilities. Over the last decade, there have been many anecdotal reports and systematic studies reporting cases of lymphomas, internal malignancies, leukemia, skin cancers and serious infections in dermatology patients on cyclosporine therapy. However, none of these studies have firmly established the malignancy or infection risk of cyclosporine at dermatological dosage. The recently published 5-year cohort study is the largest and most rigorous data to date on the long-term immunosuppressive safety profile of cyclosporine. Contrary to current belief, it demonstrates no significantly increased risk of lymphomas, leukemia, other internal malignancies or melanoma. However, it does indicate a 3.3-fold increase of non-melanoma skin cancer if cumulative cyclosporine use exceeds two years. Review of literature demonstrates only two case reports of serious infections without any suggestions of opportunistic infections or tuberculosis reactivation. Although more long-term studies are still needed, these data suggest that cyclosporine is safe at dermatological dosage and dermatologists can consider using it in their patient population.