L. Legendre

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

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.

Botulinum Toxin A: An Effective Treatment for Linear Immunoglobulin A Bullous Dermatosis Located in the Axillae

Linear immunoglobulin A bullous dermatosis (LABD) is a rare chronic disease, but it is the most frequent auto-immune bullous disease in children (1). In this age group, the eruption is characterized by a clustered arrangement of blisters, located mainly on the lower abdomen, perineum, and perioral area (2). In adults, the eruption is polymorphic, with no specific anatomical sites, and can simulate other auto-immune bullous diseases (1). Functional symptoms vary from mild pruritus to severe burning. Histological examination reveals a dense superficial dermal infiltrate made of neutrophils and eosinophils in the form of micro-abscesses on top of papillae, together with dermo-epidermal detachment. LABD is caused by IgA auto-antibodies typically directed against a proteolytic fragment of 180-kDa bullous pemphigoid antigen (BP180) detected as a 97 or 120 kDa protein on western blotting, and/or other components of the dermal–epidermal junction (3). Direct immunofluorescence is characterized by linear IgA deposits on the basal membrane. First-line treatment for LABD is dapsone, used as monotherapy or in combination with systemic corticosteroids. For patients not responding to dapsone, sulphapyridine, immunosuppressive drugs, immunoglobulins or rituximab have been advocated (4). We report here the efficacy of botulinum toxin A (BtxA) injections for LABD located in the axillae.