The long-term risk of lymphoma and skin cancer did not increase after topical calcineurin inhibitor use and phototherapy in a cohort of 25,694 patients with vitiligo

Ju, Hyun Jeong; Han, Ju Hee; Kim, Min‐Soo; Lee, Si Hyung; Shin, Jung-Won; Choi, Mira; Jeong, Kyunguk; Han, Tae Young; Choi, Chong Won; Lee, Hee Jung; Oh, Sang Ho; Lee, Sang Hoon; Kim, Dong Hyun; Shin, Jeonghyun; Lee, Jong Hee; Kim, Sang Seok; Kang, Hee Young; Chang, Sung Eun; Kim, Jeong-Soo; Lee, Dong‐Youn; Choi, Gwang Seong; Suh, Dae Hun; Kim, You Chan; Park, Chul Jong; Kim, Kiho; Lee, Ai-Young; Park, Kyoung Chan; Lee, Mu-Hyoung; Bae, Jung Min

doi:10.1016/j.jaad.2021.01.067

Cited by 28 publications

(28 citation statements)

References 29 publications

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“…The 5 studies had a total of 228 607 patients with vitiligo (110 038 who had been treated with UV phototherapy and 118 569 patients who had not). The type of phototherapy was PUVA or NB‐UVB in three studies, 9,13,14 while the other two studies included only NB‐UVB 10,15 . Regarding study quality, the NOS scores of all the included cohort studies were between 7 and 9 (Table 1, Table ), indicating that these studies had a low risk of bias.…”

Section: Resultsmentioning

confidence: 98%

“…23 Of the five studies included in our research, only two definitely indicated the mean ª 2021 British Association of Dermatologists follow-up duration, which varied from < 4 years to > 6 years. 14,15 Other studies reported that the duration of their cohort enrolment ranged from 10 to 16 years. 9,10,13 Further studies are needed to explore the appropriate follow-up time for elucidating the association between NB-UVB phototherapy and skin cancer.…”

Section: Discussionmentioning

confidence: 99%

“…The type of phototherapy was PUVA or NB-UVB in three studies, 9,13,14 while the other two studies included only NB-UVB. 10,15 Regarding study quality, the NOS scores of all the included cohort studies were between 7 and 9 (Table 1, Table S1), indicating that these studies had a low risk of bias.…”

Section: Characteristics and Quality Of Included Studiesmentioning

confidence: 99%

“…We performed a pooled analysis to determine whether the total number of phototherapy sessions affects the frequency of skin cancer. Three studies included data regarding the events of skin cancer based on the total number of phototherapy sessions 10,13,15 ; however, one study included both PUVA and NB-UVB. 13 Thus, we used only the data from the two studies that recruited patients who received only NB-UVB for pooled estimates.…”

Section: Subgroup Analyses Basedmentioning

confidence: 99%

“…We initially identified 180 relevant studies from the 4 databases; of these, 175 studies that did not meet the inclusion criteria were excluded (the study selection process is shown in Figure S1), leaving a total of 5 retrospective cohort studies, all published between 2013 and 2021, were included in the qualitative and quantitative analysis. 9,10,[13][14][15] Table 1 lists the characteristics of these studies. The 5 studies had a total of 228 607 patients with vitiligo (110 038 who had been treated with UV phototherapy and 118 569 patients who had not).…”

Section: Characteristics and Quality Of Included Studiesmentioning

confidence: 99%

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Risk of skin cancer after ultraviolet phototherapy in patients with vitiligo: a systematic review and meta-analysis

Chou

Chang

2022

Clinical and Experimental Dermatology

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Background. Although ultraviolet (UV) phototherapy is an effective treatment for vitiligo, its effect on the risk of skin cancer remains controversial. Aim. To investigate the association between UV phototherapy and skin cancer risk in patients with vitiligo. Methods. A systematic review was performed for studies published before 5 May 2021 in the PubMed, Embase, Web of Science and Cochrane Library databases. The primary outcome was the association of UV phototherapy with the risk of skin cancer in patients with vitiligo. A meta-analysis with a random-effects model was conducted. Results. Five retrospective cohort studies covering a total of 228 607 patients with vitiligo (110 038 who had been treated with UV phototherapy and 118 569 patients who had not) were included in the meta-analysis. The risk of nonmelanoma skin cancer [Mantel-Haenszel risk ratio (MHRR) = 0.95; 95% CI 0.44-2.05] and melanoma (MHRR = 1.11; 95% CI 0.33-3.82) did not significantly increase after phototherapy in patients with vitiligo. In the subgroup analysis, we also found no significant association between phototherapy with narrowband UVB phototherapy specifically and risk of skin cancer in patients with vitiligo. There was no significant difference in risk of skin cancer between patients from Europe and those from East Asia and the risk was not affected by the number of narrowband UVB phototherapy sessions.Conclusions. The findings of this systematic review and meta-analysis suggest that UV phototherapy is a safe treatment for vitiligo with no significant risk of skin cancer.

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Section: Resultsmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Characteristics and Quality Of Included Studiesmentioning

confidence: 99%

Section: Subgroup Analyses Basedmentioning

confidence: 99%

Section: Characteristics and Quality Of Included Studiesmentioning

confidence: 99%

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Risk of skin cancer after ultraviolet phototherapy in patients with vitiligo: a systematic review and meta-analysis

Chou

Chang

2022

Clinical and Experimental Dermatology

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UV Exposure and the Risk of Keratinocyte Carcinoma in Skin of Color

et al. 2022

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eratinocyte carcinoma (KC), also known as nonmelanoma skin cancer, refers to basal cell carcinoma and squamous cell carcinoma. The incidence rates of KC are much lower among people with skin of color compared with people who identify as non-Hispanic White. 1 However, KCs in individuals with skin of color can be associated with worse outcomes owing to a higher risk for tumor invasion, metastasis, atypical clinical presentations, and delays in diagnosis compared with non-Hispanic White populations. 2 Ultraviolet exposure is the strongest modifiable risk factor associated with KC, but studies establishing this association have been primarily in non-Hispanic White populations. To date, and to our knowledge, there has been no comprehensive systematic review examining the association between UV exposure and KC among individuals with skin of color. Methods Personnel, Protocol, and RegistrationThe systematic review team included 5 reviewers (E.K., F.C.P.S.L., M.A., J.P., and A.S.A.) and 1 health sciences librarian (R.B.) from the University of Texas Libraries. The systematic review was registered on March 8, 2021, in the PROSPERO database (CRD42021234735). We used the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. This research project was considered by The University of Texas at Austin Institutional Review Board as non-human participant research, and approval was not required.IMPORTANCE Ultraviolet radiation exposure is an important modifiable risk factor for keratinocyte carcinoma (KC) in fair-skinned non-Hispanic White populations; however, the evidence for this relationship in darker-skinned populations is less certain.OBJECTIVE To assess and synthesize the published data concerning the association between UV exposure and the risk of KC in individuals with skin of color.EVIDENCE REVIEW PubMed, Cochrane, and Web of Science databases were searched from database origin through January 2022. Studies deemed eligible included UV exposure as a risk factor for KC in individuals with skin of color, defined as any race other than non-Hispanic White, Fitzpatrick skin types IV to VI, or tanning ability of rarely or never burns. The UV index, irradiance, latitude, history of phototherapy, history of sunburn, or occupational exposure were used as measures of exposure. The Oxford Centre for Evidence-Based Medicine guidelines were used to assess evidence quality.FINDINGS A total of 72 716 articles appeared in the search. After duplicate removal, 29 393 database records were screened, 454 full-text articles were assessed, a forward and reverse citation search was performed, and 12 articles, with clinical data spanning the years 1990 to 2019, met inclusion criteria. More than 32 970 KCs in individuals with skin of color were included. Eight studies found no association between UV exposure and KC, while 4 studies showed a positive association. Study types included 1 ecological study, 9 cohort studies, and 2 case-control studies. The quality of the studies was rated from moderate to low...

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Expert Recommendations on Use of Topical Therapeutics for Vitiligo in Pediatric, Adolescent, and Young Adult Patients

Renert-Yuval,

Ezzedine,

Grimes

et al. 2024

JAMA Dermatol

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ImportanceEvidence-based recommendations for the treatment of vitiligo in pediatric, adolescent, and young adult patients in the US are needed.ObjectiveTo develop evidence- and consensus-based expert recommendations on the diagnosis and treatment of vitiligo in young patients.Evidence ReviewA process was developed to produce consensus recommendations addressing questions regarding pediatric vitiligo. A librarian-conducted literature review was performed using articles that met the inclusion criteria: published in English, containing primary data (including meta-analysis) and pediatric-specific data, and analysis of 6 or more patients. Included articles were graded by the Strength of Recommendation Taxonomy criteria and Oxford Centre for Evidence-based Medicine’s Levels of Evidence and Grades of Recommendation. Research questions were reviewed on May 9, 2022, through a video conference. One month after the conference, participants participated in an online survey documenting their level of agreement with the generated statements, using a 5-point Likert scale.FindingsArticles on topical corticosteroids and/or topical calcineurin inhibitors (n = 50), topical Janus kinase inhibitors (n = 5), pseudocatalase (n = 2), and microdermabrasion (n = 2) met inclusion criteria. Forty-two recommendations were made on the diagnosis of vitiligo and optimal topical therapeutics, with 33 recommendations obtaining a 70% or greater composite agreement and strong agreement. Topical calcineurin inhibitors twice daily, topical corticosteroids with time limitation due to atrophy risk, and topical ruxolitinib, 1.5%, cream—used off-label for patients younger than 12 years and limited to nonsegmental vitiligo—were identified as evidence-based first-line therapies in the management of pediatric and adolescent patients, with specific guidance on age-based data, minimum therapeutic trial of 6 months or greater, prolonged therapy to prevent recurrence, and the positive benefit of coordinated use of UV therapeutic sources.Conclusions and RelevanceEvidence supports the use of topical calcineurin inhibitors, topical corticosteroids, and topical Janus kinase inhibitors as effective therapeutics for vitiligo in pediatric, adolescent, and young adult patients, with specific decisions on choice of agent based on factors such as site location, body surface area, and age.

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The long-term risk of lymphoma and skin cancer did not increase after topical calcineurin inhibitor use and phototherapy in a cohort of 25,694 patients with vitiligo

Cited by 28 publications

References 29 publications

Risk of skin cancer after ultraviolet phototherapy in patients with vitiligo: a systematic review and meta-analysis

Risk of skin cancer after ultraviolet phototherapy in patients with vitiligo: a systematic review and meta-analysis

UV Exposure and the Risk of Keratinocyte Carcinoma in Skin of Color

Expert Recommendations on Use of Topical Therapeutics for Vitiligo in Pediatric, Adolescent, and Young Adult Patients

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