CLL Associated With Increased Skin Cancer Risk and Worse Outcomes
Key points:
- Cohort study of more than 13,000 patients with psoriasis evaluated paradoxical eczema risk during biologic therapy
- Overall incidence was low (~1%), but varied by drug class
- IL-23 inhibitors were associated with the lowest risk compared with other biologics
- Higher risk observed in patients with prior atopic dermatitis, hay fever, older age, and female sex
- Findings may inform biologic selection and management of adverse skin reactions
The analysis used data from a multicenter registry in the UK and Ireland, including more than 13,000 patients with psoriasis and nearly 25,000 biologic treatment exposures. Investigators evaluated the incidence of paradoxical eczema—an atopic dermatitis–like reaction that can occur during biologic therapy—and assessed how risk varied by treatment type and patient characteristics.
Overall, paradoxical eczema was found to be uncommon, occurring in approximately 1% of biologic exposures. However, risk differed by drug class. Patients receiving interleukin-23 (IL-23) inhibitors had the lowest risk compared with other biologics, including tumor necrosis factor (TNF) inhibitors and interleukin-17 (IL-17) inhibitors.
The study also identified several factors associated with increased risk of paradoxical eczema. Older age, a prior history of atopic dermatitis, and a history of hay fever were all linked to higher likelihood of developing the condition. Female sex was also associated with increased risk, while male sex was associated with lower risk.
In contrast, no significant association was observed between asthma and paradoxical eczema risk. The findings suggest that underlying atopic predisposition—particularly conditions such as atopic dermatitis and allergic rhinitis—may play a role in susceptibility to this adverse effect.
Although IL-17 inhibitors showed numerically higher rates of paradoxical eczema, the differences compared with some other biologic classes were not statistically significant in all comparisons. The authors noted that the overall low incidence may be reassuring for clinicians and patients but emphasized that the reaction can still impact treatment decisions, including discontinuation or the need for additional therapy.
The study highlights the complexity of immune modulation in psoriasis, where biologic therapies targeting specific inflammatory pathways may shift immune balance and contribute to alternate inflammatory phenotypes. The authors suggest that further research is needed to better understand the mechanisms underlying paradoxical eczema and to confirm differences between biologic classes.