At 52, how to treat psoriasis flare with lymphoma?

Question

Hello doctor,

I am 52 years old, and my psoriasis exploded since starting chemotherapy for lymphoma, covering 70 percent of my body and joints. The oncologist says that the treatment can not be stopped because the tumor is shrinking. I tried every cream but the skin burned like fire. Even got patches in the mouth making eating painful- how to manage?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I can understand your concern.

Your situation is challenging due to the overlap of chemotherapy-induced psoriasis exacerbation and swollen joints suggestive of psoriatic arthritis. Here is an urgent plan:

Skin and psoriatic arthritis management-

Consider starting cyclosporine or low-dose Methotrexate (safe during chemotherapy, under oncologist approval) to suppress psoriasis and joint inflammation quickly. Biologics like TNF (tumor necrosis factor) inhibitors (e.g., Etanercept) could be considered if chemotherapy allows.
Use high-potency corticosteroids (e.g., Clobetasol) for immediate relief. Apply coal tar or Salicylic acid preparations to reduce scaling.
Use thick emollients (e.g., petroleum jelly or ceramide creams) multiple times a day to soothe burning.

Mouth lesions:

Rinse with Benzydamine or Chlorhexidine mouthwash to reduce pain and prevent infections.
Use a topical corticosteroid gel (e.g., Triamcinolone dental paste).
Eat soft, non-spicy foods, and ensure hydration.

Pain and joint swelling:

Use non-steroidal anti-inflammatory drugs (NSAIDs) cautiously (only if kidney function and platelet count permit).
Consider short-term low-dose corticosteroids under an oncologist's supervision.

Ensure a dermatologist and rheumatologist work with your oncologist to adjust treatments safely without compromising lymphoma care.

Monitor for infections as chemotherapy and psoriasis compromise skin integrity and immunity. Treat any secondary skin infections aggressively.

Seek urgent dermatology and rheumatology consultations to tailor treatment while continuing chemotherapy. Hospital care might be necessary for pain, immobility, and severe skin involvement.

I hope this helps.

Kindly follow up if you have more concerns.

Thank you.