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

J Am Acad Dermatol. 2015 Jun;72(6):992-1002. doi: 10.1016/j.jaad.2015.02.1116. Epub 2015 Apr 1.


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.

Keywords: atopic dermatitis; lymphoma; neoplasm; pimecrolimus; systematic review; tacrolimus; topical corticosteroids.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Administration, Topical
  • Adrenal Cortex Hormones / adverse effects
  • Adrenal Cortex Hormones / therapeutic use
  • Age Distribution
  • Calcineurin Inhibitors / adverse effects*
  • Calcineurin Inhibitors / therapeutic use
  • Comorbidity
  • Dermatitis, Atopic / diagnosis
  • Dermatitis, Atopic / drug therapy*
  • Dermatitis, Atopic / epidemiology*
  • Female
  • Humans
  • Immunosuppressive Agents
  • Incidence
  • Lymphoma, T-Cell, Cutaneous / diagnosis
  • Lymphoma, T-Cell, Cutaneous / epidemiology*
  • Male
  • Prognosis
  • Risk Assessment
  • Severity of Illness Index
  • Sex Distribution
  • Skin Neoplasms / diagnosis
  • Skin Neoplasms / epidemiology*
  • Tacrolimus / adverse effects
  • Tacrolimus / therapeutic use


  • Adrenal Cortex Hormones
  • Calcineurin Inhibitors
  • Immunosuppressive Agents
  • Tacrolimus