16-05-2025
Atopic Dermatitis Linked to Higher Odds of NMSC
SAN DIEGO — Patients with atopic dermatitis (AD) are at a significantly higher risk for nonmelanoma skin cancer (NMSC), although the overall risk remains low, a new retrospective database study found.
Compared with patients without AD, the odds of NMSC in patients with AD were 1.53 times higher in an adjusted analysis (odds ratio [OR], 1.53; 95% CI, 1.17-2.01; P < .05), according to a study of 2021 national survey data presented here at the annual meeting of the Society for Investigative Dermatology.
'The strength of that association surprised us, as well as the consistent findings across various demographic groups. It adds weight to the theory that AD isn't just a quality-of-life disease but may have more serious systemic consequences,' said study lead author Lara Shqair, medical student at the Icahn School of Medicine at Mount Sinai, New York City, in an interview with Medscape Medical News .
Other studies have examined possible relationships between AD and NMSC. A 2024 study using US claims data linked any AD and moderate to severe AD to higher rates of NMSC (relative risk, 1.32; 95% CI, 1.30-1.35 and 1.36; 95% CI, 1.12-1.65, respectively). And a 2023 study found that among various malignancies in patients with moderate to severe AD, incidence rates were highest for NMSC (moderate AD: 4.6; 95% CI, 3.9-5.5; severe AD: 5.9; 95% CI, 3.8-9.2).
However, 'what was missing was a large, nationally representative study that could give us a clearer picture of this relationship in the general United States population,' said Shqair, who presented the results at the meeting. That's where the new research comes in.
Shqair and colleagues evaluated the association between AD and NMSC via 29,116 participants — 7.4% with self-reported AD and 2.7% with NMSC — in the 2021 National Health Interview Survey. Overall, an estimated 3.6 million cases of basal cell carcinoma and 1.8 million cases of squamous cell carcinoma — the two most common types of NMSC — are diagnosed in the United States each year.
In an unweighted analysis, 2.0% of the non-AD population and 2.8% of the AD population had NMSC ( P < .05). After researchers weighted the data for age, sex, race, insurance type, education level, and NMSC prevalence, they determined that patients with AD had a higher risk for NMSC.
Why might AD and NMSC be related? One possibility is that chronic skin inflammation promotes cancer through local immune dysregulation, Shqair said. Another possibility is that systemic immunosuppressive treatments could increase their risk, 'and there's also the role of barrier dysfunction and transcutaneous sensitization, potentially allowing more exposure to carcinogens,' she added.
In the big picture, she said, excess risk is likely due to 'a combination of biological, treatment-related, and behavioral factors.'
The researchers also found that women (63% of the AD cases) and patients with private insurance (64%) were more likely to have AD. In their adjusted analysis, AD was linked to higher levels of education (some college education, OR, 0.47; 95% CI, 1.18-1.83; P < .05, and holding a professional degree (OR, 2.41; 95% CI, 1.85-3.13; P < .05) vs high school degree or lower.
'People with more education may be more proactive about their health and more likely to seek dermatologic care,' Shqair said. Other factors may be at play 'such as differences in health literacy, insurance coverage, trust in the medical system, and the ability to take time off work or afford specialized care.'
The study's overall message is that 'dermatologists should be aware that patients with AD, especially those with severe or long-standing disease, might be at elevated risk for NMSC,' she said.
The new study complements previous analyses and is consistent with their findings, said Christopher G. Bunick, MD, PhD, associate professor of dermatology at Yale University, New Haven, Connecticut, who was not involved in the research.
The apparent extra risk 'indicates patients with AD may require careful education on sun protection and may need to undergo routine skin screenings on a consistent basis,' Bunick told Medscape Medical News . 'I recommend a combination of education around risk of NMSC and the need for sun protection and the strict avoidance of tanning beds.'
