Topical Calcineurin Inhibitors and Malignancy Risk

Context The approval of topical calcineurin inhibitors (TCIs) has been a significant breakthrough for the treatment of atopic dermatitis due to much lower systemic absorption and not causing skin atrophy even after long-term use that have made them become popular replacements for topical corticosteroids being almost equally effective. In January 2006, the US food and drug administration (FDA), followed later also by the European medicine agency (EMEA), issued the “black box” warning causing controversy regarding a potential increased risk of lymphoma in patients with atopic dermatitis and treated with TCIs. Evidence Acquisition PubMed and MEDLINE^® databases were systematically searched utilizing a variety of terms relating to the subject matter. Articles written only in English over the past 15 years were analyzed and selected for review. Results So far, no scientific evidence of the association has been found between use of TCIs, and increased incidence of skin cancers and lymphomas in patients with AD. The systematic review and meta-analysis by Legendre et al. found the role of TCIs unlikely to be a significant risk factor of lymphoma in those patients. Conclusions Despite an extensive body of evidence regarding the TCIs safety, the box warning still remains leaving the physicians and patients unduly uncertain and confused about the safety of TCI use.