Lymphoma among patients with atopic dermatitis and/or treated with topical immunosuppressants in the United Kingdom.
BACKGROUND
Atopic dermatitis (AD) has been associated with an increased risk of lymphoma.


OBJECTIVE
To assess the risk of lymphoma associated with AD and use of topical corticosteroids (TCS) or topical calcineurin inhibitors (TCI) in a database allowing medical record validation.


METHODS
We conducted a nested-case control study using the United Kingdom-based The Health Improvement Network (THIN) database. We excluded patients with established risk factors for lymphoma. Cases of lymphoma were identified and classified after review of the medical records and hospital discharge files.


RESULTS
In the study population of 3,500,194 individuals, we identified 2738 cases of lymphoma (1722 non-Hodgkin lymphoma [NHL], 466 Hodgkin disease, 550 indeterminate cases; overall, 188 had cutaneous involvement) and 10,949 matched controls. AD was associated with an increased lymphoma risk (odds ratio [OR], 1.83; 95% CI, 1.41-2.36). In patients with AD referred to a dermatologist, the OR further increased (OR, 3.72; 95% CI, 1.40-9.87). We did not find any cases of lymphoma in TCI users; however, the number of patients exposed to TCI was insufficient to study any possible association between lymphoma and these drugs. TCS use was associated with an increased lymphoma risk (OR, 1.46; 95% CI, 1.33-1.61). The risk increase was dependent on TCS potency (OR for high-potency TCS, 1.80; 95% CI, 1.54-2.11). The increased risk involved both Hodgkin disease and NHL, especially NHL with skin involvement (OR for high-potency TCS, 26.24; 95% CI, 13.49-51.07).


CONCLUSIONS
Our results show an association between lymphoma-especially skin lymphoma-and use of TCS. The risk increased with duration of exposure and potency of TCS.
Arellano
Felix M
FM
Risk MR, LLC, Bridgewater, NJ, USA. arellano@riskmr.com
Arana
Alejandro
A
Wentworth
Charles E
CE
Fernández-Vidaurre
Carlos
C
Schlienger
Raymond G
RG
Conde
Eulogio
E
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003876:Dermatitis, Atopic / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007223:Infant; D007231:Infant, Newborn; D008223:Lymphoma / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents