In this installment of Topical Conversations, James Q Del Rosso, DO, discusses the risk of malignancies in patients with atopic dermatitis (AD). He explores the potential correlation between malignancies and specific therapies, particularly considering boxed warnings on Janus kinase (JAK) inhibitors and their associated adverse events. 

Understanding AD therapies and malignancy risk 

Dr Del Rosso highlights the importance of scrutinizing the risk of malignancies, which can be categorized into 2 types: nonmelanoma skin cancer and other malignancies. He notes that certain therapies commonly used for AD, such as immunosuppressive agents like methotrexate, cyclosporine, and systemic corticosteroids, may be associated with an increased risk of malignancies. For instance, cyclosporine may raise concerns about lymphoproliferative malignancies, especially considering the medical history of many AD patients. 

Considering population data 

However, he also discusses population data suggesting that there is not a significant relationship between AD and an increased risk of malignancy compared to individuals without AD. Despite this encouraging finding, he underscores the importance of vigilance, particularly because patients with AD often undergo various therapeutic regimens. 

The dermatologists’s role in comprehensive patient care 

In managing patients with AD, he advocates for a comprehensive approach, emphasizing the necessity of conducting thorough skin examinations, encouraging photoprotection, and maintaining a dermatologist's role in patient management beyond prescribing medications.