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Ju HJ, Han JH, Kim MS, Lee SH, Shin JW, Choi M, Jeong KH, Han TY, Choi CW, Lee HJ, Oh SH, Lee SH, Kim DH, Shin J, Lee JH, Kim SS, Kang HY, Chang SE, Kim JS, Lee DY, Choi GS, Suh DH, Chan Kim Y, Park CJ, Kim KH, Lee AY, Chan Park K, Lee MH, Bae JM. 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. J Am Acad Dermatol 2021; 84:1619-1627. [PMID: 33508387 DOI: 10.1016/j.jaad.2021.01.067] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND Topical calcineurin inhibitors have been used to treat vitiligo, either alone or in combination with phototherapy; however, the long-term safety of these agents remains controversial. OBJECTIVE To investigate the risk of lymphoma and skin cancer in vitiligo patients who received topical calcineurin inhibitors or phototherapy. METHODS A multicenter retrospective cohort study of 25,694 vitiligo patients who received topical calcineurin inhibitors or phototherapy for 6 weeks or more between 2001 and 2019 was performed. Cumulative doses of topical calcineurin inhibitors and total phototherapy sessions were determined. Outcomes were the development of lymphoma or skin cancer after enrollment, confirmed through chart review and pathology reports. RESULTS During 95,203 person-years, 13 cases of lymphoma, 22 of actinic keratosis, 15 of nonmelanoma skin cancer, and 5 of melanoma were observed. The risk of lymphoma and skin cancer was not significantly increased by topical calcineurin inhibitor dose or phototherapy sessions. The interaction between the topical calcineurin inhibitors and phototherapy was not associated with an increased risk of skin cancer. LIMITATIONS Retrospective study, individual follow-up duration less than 4 years, and no adjustment for comorbidities and medication history. Not generalizable to other races. CONCLUSION The long-term risk of skin cancer or lymphoma was not associated with the use of topical calcineurin inhibitors, phototherapy, and both treatments in combination in patients with vitiligo.
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Affiliation(s)
- Hyun Jeong Ju
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Ju Hee Han
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Min-Soo Kim
- Department of Dermatology, Veterans Health Service Medical Center, Seoul, South Korea
| | - Si-Hyung Lee
- Department of Dermatology, Seoul National University College of Medicine, South Korea
| | - Jung-Won Shin
- Department of Dermatology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Mira Choi
- Department of Dermatology, Inje University Ilsan Paik Hospital, Seoul, South Korea
| | - Ki-Heon Jeong
- Department of Dermatology, College of Medicine, Kyung Hee University, Seoul, South Korea
| | - Tae Young Han
- Department of Dermatology, Eulji General Hospital, Eulji University, Seoul, South Korea
| | - Chong Won Choi
- Department of Dermatology, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Hee Jung Lee
- Department of Dermatology, Cha University Bundang Cha Medical Center School of Medicine, Bundang, South Korea
| | - Sang Ho Oh
- Department of Dermatology and Cutaneous Biology Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Sang Hoon Lee
- Department of Dermatology, Soon Chun Hyang University Hospital, Bucheon, South Korea
| | - Dong Hyun Kim
- Department of Dermatology, Cha University Bundang Cha Medical Center School of Medicine, Bundang, South Korea
| | - Jeonghyun Shin
- Department of Dermatology, Inha University School of Medicine, Incheon, South Korea
| | - Jong Hee Lee
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sang Seok Kim
- Department of Dermatology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Hee Young Kang
- Department of Dermatology, Ajou University School of Medicine, Suwon, South Korea
| | - Sung Eun Chang
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jeong-Soo Kim
- Department of Dermatology, Hanyang University College of Medicine, Seoul, South Korea
| | - Dong-Youn Lee
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Gwang Seong Choi
- Department of Dermatology, Inha University School of Medicine, Incheon, South Korea
| | - Dae Hun Suh
- Department of Dermatology, Seoul National University College of Medicine, South Korea
| | - You Chan Kim
- Department of Dermatology, Ajou University School of Medicine, Suwon, South Korea
| | - Chul Jong Park
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Ki-Ho Kim
- Department of Dermatology, Dong-A University School of Medicine, Busan, South Korea
| | - Ai-Young Lee
- Department of Dermatology, Dongkuk University Ilsan Hospital, Dongguk University Graduate School of Medicine, Goyang, South Korea
| | - Kyoung Chan Park
- Department of Dermatology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Mu-Hyoung Lee
- Department of Dermatology, College of Medicine, Kyung Hee University, Seoul, South Korea
| | - Jung Min Bae
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
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Lan CCE, Yu HS, Lu JH, Wu CS, Lai HC. Irradiance, but not fluence, plays a crucial role in UVB-induced immature pigment cell development: new insights for efficient UVB phototherapy. Pigment Cell Melanoma Res 2013; 26:367-76. [PMID: 23398671 DOI: 10.1111/pcmr.12077] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Accepted: 02/04/2013] [Indexed: 01/28/2023]
Abstract
Light exposure modulates development of living organisms. In the field of medicine, light has frequently been used for regenerative purposes. Excimer light (308 nm) has demonstrated superior efficacy in treating vitiligo, a condition requiring development of melanoblasts and a model for studying nerve cell regeneration, as compared to narrow-band ultraviolet B (NBUVB; 311 nm). Using mouse-derived melanoblast cells to examine the pro-differentiation effects of these two light sources, we demonstrated that at equivalent fluence, excimer light induces melanoblast differentiation, while NBUVB failed to so. Mechanistically, activation of aryl hydrocarbon receptor pathway and nuclear translocation of epidermal growth factor receptor are involved in pro-differentiation effects of excimer light. Reduction in irradiance by filter abrogated the effects of excimer light in melanoblasts, even when equivalent fluence was delivered by the same light source. As ultraviolet B (UVB) irradiation is closely associated pigment cell development, future therapy employing UVB for pigmentation purposes should incorporate irradiance as a crucial specification.
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Affiliation(s)
- Cheng-Che E Lan
- Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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