Abstract
Immunosuppressants were initially developed for the treatment of conditions such as rheumatoid arthritis, cancer and organ transplantation but these are now also preferred by dermatologist for treating severe cases of steven johnson syndrome, toxic epidermal necrolysis, pemphigus vulgaris and many other dermatologic conditions. These drugs require a close scrutiny for the possibility of immunosuppressant induced malignancy. Many studies have demonstrated malignancy risk with organ transplantation and autoimmune diseases like rheumatoid arthritis, psoriasis and multiple sclerosis. Similarly certain drugs are reported to induce malignancy while treating dermatologic disorders. The risk of bladder cancer is associated with the use of Cyclophosphamide whereas the risk of lymphoma is associated with the use of methotrexate, cyclosporine and certain TNF (tumour necrosis factor) inhibitors. Likewise, it has been reported that there is increased risk of squamous as well as basal cell carcinoma when PUVA (psoralen and ultraviolet A) phototherapy is given. . Certain measures can be applied for the prevention of possible malignancy. Educating the patient on early signs and symptoms can aid the clinicians in preventing malignancy. Furthermore, determining the drug causation using CDR (challenge-dechallenge-rechallenge) step or utilizing the available databases such as SEER (Surveillance epidemiology and end results) and disease specific databases can help in determining the incidence of malignancy and come up with suitable solutions. However, these methods provide limited information and a confident conclusion concerning malignancy risk associated with immunosuppressants use cannot be made. Nevertheless, rough analysis can always be made using these methods for early detection and prevention of malignancy.
