Therapeutic Options for Psoriasis and Eczematous Dermatitis in Cancer Patients

Conclusions

• For psoriasis in patients with cancer, non-immunosuppressive options such as topical agents, narrowband UVB, acitretin, and apremilast appear to be the safest first choices.
• IL-17 and IL-23 inhibitors generally do not show an increased malignancy signal in trials and observational studies, and IL-23 inhibitors appear especially reassuring in patients with a cancer history.
• TNF-alpha inhibitors and methotrexate warrant more caution because of more consistent associations with non-melanoma skin cancer and lymphoma risk.
• In patients with eczematous dermatitis and cancer, topical corticosteroids, topical calcineurin inhibitors, and phototherapy are reasonable initial options, with the current evidence not showing a meaningful malignancy increase for topical calcineurin inhibitors.
• Dupilumab can be effective and is generally considered safe for cancer patients, including some with immune checkpoint inhibitor-related skin eruptions, but older patients with atypical or refractory dermatitis should be biopsied to exclude CTCL before starting it.
• Newer topical and systemic biologic therapies such as lebrikizumab, tralokinumab, nemolizumab, and topical nonsteroidal agents have not yet shown strong malignancy signals, but long-term cancer safety data remain limited.
• JAK inhibitors may be usable in selected cancer patients, but the oral surveillance data and class warnings support extra caution, especially in older patients with cardiovascular or smoking risk factors.
• Overall management should follow a stepwise therapeutic ladder and be individualized through shared decision making with the oncologist, especially when escalating to more immunosuppressive treatments.