BMJ Open (Mar 2023)

Rates of malignancies among patients with moderate to severe atopic dermatitis: a retrospective cohort study

  • Fei Xu,
  • Maryam M Asgari,
  • Jamie Geier,
  • Charles P Quesenberry,
  • Monique M Hedderson,
  • Sneha Sridhar,
  • Adina R Lemeshow

DOI
https://doi.org/10.1136/bmjopen-2022-071172
Journal volume & issue
Vol. 13, no. 3

Abstract

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Objectives Patients with atopic dermatitis (AD), also known as eczema, may be at an increased risk for malignancies compared with patients without AD; however, incidence rates (IRs) of malignancies in patients with moderate to severe AD are largely unknown. The objective of this study was to evaluate and compare IRs of malignancies in adults with moderate to severe AD (aged ≥18 years).Design Retrospective cohort study using data from a Kaiser Permanente Northern California (KPNC) cohort. AD severity classification was adjudicated with medical chart review. Covariates and stratification variables included age, sex and smoking status.Setting Data were obtained from the KPNC healthcare delivery system in northern California, USA. Cases of AD were defined by outpatient dermatologist-rendered codes and prescriptions of topical therapy or phototherapy (moderate) or systemic treatment (severe).Participants KPNC health plan members with moderate or severe AD (2007–2018).Primary and secondary outcome measures Malignancy IRs and 95% CIs per 1000 person-years were calculated.Results 7050 KPNC health plan members with moderate and severe AD met eligibility criteria for inclusion. IRs (95% CI) were highest for non-melanoma skin cancer (NMSC) in patients with moderate and severe AD (4.6 (95% CI 3.9 to 5.5) and 5.9 (95% CI 3.8 to 9.2), respectively) and breast cancer (2.2 (95% CI 1.6 to 3.0) and 0.5 (95% CI 0.1 to 3.9), respectively). Except for breast cancer, which was only evaluated in women, malignancies were higher (with non-overlapping CIs) in patients with moderate and moderate to severe AD in men versus women for basal cell carcinoma and NMSC and in former versus never smokers for NMSC and squamous cell carcinoma.Conclusions This study estimated IRs of malignancies in patients with moderate and severe AD and provides valuable information for dermatology clinicians and ongoing clinical trials in these populations.