Level of UV Exposure, Skin Type, and Age Are More Important than Thiopurine Use for Keratinocyte Carcinoma Development in IBD Patients
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Retrospective studies observe an increased risk of keratinocyte carcinomas (KCs) in patients with inflammatory bowel disease (IBD) on thiopurine (TP) medication. The role of traditional risk factors such as skin type and sun protection behavior has not been studied in this population. This study aimed to examine traditional KC risk factors and thiopurine use on skin cancer development in an IBD cohort.
Consecutive IBD patients were recruited from four specialist centers in Australia and New Zealand, each with varying UV exposure indices. Data pertaining to race, skin color, freckling and sun protection behavior, dose of TP therapy, and skin cancer development were elicited through a self-reported questionnaire.
A total of 691 IBD patients were included with 62 reporting KC development. Thiopurine usage was similar among patients who developed skin cancer compared with those who did not (92% vs. 89%, p = 0.3). There was no statistically significant association between KC development and TP dose or 6-thioguanine nucleotide levels. In multivariate modeling, four factors were independently and significantly associated with KC: age over 61 years old versus less than 30 years old (OR 6.76; 95% CI 2.38–19.18), residing in Brisbane versus Christchurch (OR 3.3; 95% CI 1.6–6.8), never staying in the shade versus staying in the shade ≥ 50% of the time (OR 3.8; 95% CI 1.4–10.5), and having a skin type that never tanned versus other skin types (OR 6.9; 95% CI 2.9–16.0).
Skin type, age, and sun protection behavior are more important risk factors for KC development than thiopurine medication use in this IBD population.
KeywordsImmunosuppression Inflammatory bowel disease Skin cancer
This work was supported by an educational grant from Abbvie. David Whiteman has received Research Fellowship (APP1058522) from the National Health and Medical Research Council of Australia (NHMRC).
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no competing interests.
- 9.Timmer A, Patton PH, Chande N, McDonald JW, MacDonald JK. Azathioprine and 6-mercaptopurine for maintenance of remission in ulcerative colitis. Cochrane Database Syst Rev. 2016;5:CD000478.Google Scholar
- 18.Van Schaik FD, van Oijen MG, HM Smeets, van der Heijden GJ, Siersema PD, Oldenburg B. Risk of nonmelanoma skin cancer in patients with inflammatory bowel disease who use thiopurines is not increased. Clin Gastroenterol Hepatol. 2011;9:449e1–450e1. author reply 450–451.Google Scholar
- 19.Setshedi M, Epstein D, Winter TA, Myer L, Watermeyer G, Hift R. Use of thiopurines in the treatment of inflammatory bowel disease is associated with an increased risk of non-melanoma skin cancer in an at-risk population: a cohort study. J Gastroenterol Hepatol. 2012;27:385–389.CrossRefGoogle Scholar
- 32.Australian Institute of Health and Welfare. 2016. Skin cancer in Australia. Cat. no. CAN 96. Canberra: AIHW.Google Scholar