title: Risk of lymphoma in patients with atopic dermatitis and the role of topical treatment: A systematic review and meta-analysis.
abstract: 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.
  
  
  CONCLUSIONS
  Confusion between severe AD and cutaneous T-cell lymphoma may account for part of the increased risk of lymphoma in patients with AD.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Dermatology, Paul Sabatier University, Toulouse, France.
authors.forename: Laureline
authors.initials: L
authors.lastname: Legendre
authors.affiliation: Department of Rheumatology, Bordeaux University Hospital, Bordeaux, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Barnetche
authors.affiliation: Department of Dermatology, Paul Sabatier University, Toulouse, France.
authors.forename: Juliette
authors.initials: J
authors.lastname: Mazereeuw-Hautier
authors.affiliation: Department of Dermatology, Paul Sabatier University, Toulouse, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Meyer
authors.affiliation: Department of Dermatology, University of New South Wales, Sydney, Australia.
authors.forename: Dedee
authors.initials: D
authors.lastname: Murrell
authors.affiliation: Department of Dermatology, Paul Sabatier University, Toulouse, France. Electronic address: paul.c@chu-toulouse.fr.
authors.forename: Carle
authors.initials: C
authors.lastname: Paul
mesh_terms: D000287:Administration, Topical; D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000627:therapeutic use; D017677:Age Distribution; D065095:Calcineurin Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D015897:Comorbidity; D003876:Dermatitis, Atopic / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents; D015994:Incidence; D016410:Lymphoma, T-Cell, Cutaneous / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D011379:Prognosis; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D012878:Skin Neoplasms / Q000175:diagnosis / Q000453:epidemiology*; D016559:Tacrolimus / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D000305:Adrenal Cortex Hormones; D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D016559:Tacrolimus
keywords: atopic dermatitis; lymphoma; neoplasm; pimecrolimus; systematic review; tacrolimus; topical corticosteroids