Original article
Risk of lymphoma in patients with atopic dermatitis and the role of topical treatment: A systematic review and meta-analysis

https://doi.org/10.1016/j.jaad.2015.02.1116Get rights and content

Background

There is controversy regarding a potential increased risk of lymphoma in patients with atopic dermatitis (AD).

Objective

To assess the risk of lymphoma and the role of topical treatments in patients with AD.

Methods

A systematic literature search and a separate meta-analysis were performed on case control and cohort studies.

Results

Of the 3979 articles retrieved, 24 references met the inclusion criteria. In cohort studies, the risk of lymphoma was slightly increased, with a relative risk (RR) of 1.43 (95% confidence interval [CI], 1.12-1.81). In case control studies, no significant increased risk of lymphoma was found, with an odds ratio (OR) of 1.18 (95% CI, 0.94-1.47). Severity of AD was a significant risk factor. Highly potent topical steroids were associated with an increased risk of lymphoma. For topical calcineurin inhibitors (TCIs), a significant association between tacrolimus and mostly skin lymphoma was found in 1 study.

Limitations

Confusion between severe AD and cutaneous T-cell lymphoma may account for part of the increased risk of lymphoma in patients with AD.

Conclusion

This systematic literature review shows a slightly increased risk of lymphoma in patients with AD. Severity of AD appears to be a significant risk factor. The role of topical steroids and TCIs is unlikely to be significant.

Section snippets

Systematic literature search

We performed a systematic review of original studies investigating the risk of lymphoma in patients with AD published between 1980 and February 28, 2014. The Cochrane, PubMed, and Scopus databases were systematically searched. The literature search used the following combination of Medical Subject Headings (MeSH): “atopic dermatitis AND lymphoma.” A second combination was systematically searched in the same databases: “atopic dermatitis AND neoplasm.” A third combination was systematically

Results

From an initial selection of 2046 references, 2019 articles were excluded after reading the title or abstract and 17 were excluded after reading the article. Fourteen articles were added by searching references lists from selected articles. In total, 24 references were retained. The study selection process is summarized in Fig 1. A systematic quantitative evaluation of the Newcastle–Ottawa scale was performed. According to this scale, the maximum number of quality stars a study publication can

Discussion

This systematic review indicates a modest increase in the risk of lymphoma in patients with AD compared to the general population, although the heterogeneity in case control studies prevents us from drawing a definite conclusion. This increased risk appears to be statistically significant in the meta-analysis of cohort studies,9, 19, 22, 23 with an overall RR of 1.43 (95% CI, 1.12-1.81). The use of highly potent TCSs was associated with a small increase in lymphoma risk, statistically

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  • Cited by (0)

    Funding sources: None.

    Dr Paul is consultant and investigator for Astellas and Novartis. Dr Meyer is a speaker for and on the advisory board of Roche and BMS, on the advisory board for Amgen, and is a speaker for MSD and AbbVie. None of the grants or honoraria were directly related to this study. Drs Legendre, Barnetche, Mazereeuw-Hautier, and Murrell have no conflicts of interest to declare.

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