LAUSR

Commentary to JEADV 2017-1413.R1 ‘Is there an increased risk of cervical neoplasia in atopic dermatitis patients treated with oral immunosuppressive drugs?’ Infection with certain genotypes of human papillomavirus (HPV) is causally linked to cervical neoplasia as nearly nine of 10 cervical cancer cases can be attributed to these high-risk types. Genital HPV infection is very common but transient in most women. Despite their oncogenic potential, the high-risk HPV types are considered necessary but not sufficient cause of malignant progression. Among cofactors are smoking and other factors that cause impaired immune system locally or systemically. In other words, the natural course of the infection may be altered in immunocompromised individuals. This leads us to the question whether immunosuppressive therapy for atopic dermatitis increases the risk of cervical neoplasia such as the title of the short report by Garritsen et al. in this issue of JEADV. The authors studied 189 patients with AD receiving different types of immunosuppressive drugs for a median duration of 407 days and found no cases of cervical carcinoma. This is in line with a Finnish retrospective cohort study of 272 patients treated with cyclosporine, who found the overall risk of cancer to be almost identical to that expected in the general population. This is contrary to the well-documented association between immunosuppression and increased risk of HPVinduced neoplasia in HIV-infected and organ transplant recipients. These groups of patients are immunosuppressed for a longer period of time; thus, it may be reasonable to conclude that short-term immunosuppressive treatment for AD probably is safe(r). However, it can be difficult to predict about the future and duration of treatment for a young woman with severe and recalcitrant AD. Based on current data and knowledge, it is difficult to rule out the possibility that even short-course immunosuppressive therapy may alter the natural course of HPV infection in young women that may turn into subsequent malignancy. Avoiding continuous treatment and try dose-sparing combinations with topical treatment may be worth trying if patients are compliant. In line with UpToDate, the authors recommend common guidelines for cervical cancer screening. Given the long pre-invasive state of precancer lesions, it is rational not to advice intensified screening intervals in immunosuppressed individuals. However, with the observation of a declining uptake among young women in cervical screening programmes, we ought to remind our patients to participate and make sure they follow the guidelines. Another important message is to advice young patients with AD about HPV vaccination. According to current HPV vaccination guidelines, immunocompromising conditions that warrant a three-dose schedule of vaccination include immunosuppressive therapy. A.O. Olsen* Olafiaklinikken & Norwegian National Advisory Unit on Sexually Transmitted Infections, Oslo University Hospital, Oslo, Norway, Institute of Clinical Medicine, University of Oslo, Oslo, Norway *Correspondence: A.O. Olsen. E-mail: [email protected]