Re-Evaluating Limitations in Atopic Dermatitis Meta-Analysis Is Important in Interpreting its Results

A recently published systematic review and meta-analysis concludes that topical calcineurin inhibitors (TCIs) used in atopic dermatitis (AD) increase risk of lymphoma. We believe this study has weaknesses that have not been adequately addressed by the authors and its results must therefore be interpreted with caution. According to study results only pimecrolimus used for AD was statistically significantly associated with lymphoma, and not TCIs in general. Unclear participant baseline immunocompetence and short follow-up duration limit the study's ability to detect malignancy risk. AD has been linked to an increased risk of lymphoma; however, cutaneous lymphoma can be misdiagnosed as AD, which makes it possible that the disease itself rather than treatment with TCIs could account for any increased likelihood of lymphoma in these patients. It is important that clinicians not be wrongfully made more reserved and insecure about prescribing TCIs in the future.