Risk of Cutaneous T-Cell Lymphoma Associated with Biologic Therapy for Inflammatory Skin Diseases: A Comprehensive Review

The diagnosis and treatment of cutaneous T-cell lymphoma (CTCL), a rare and serious skin malignancy, remain challenging due to limited understanding of its pathogenesis. Recently, increasing attention has been directed toward a possible link between CTCL development and the use of biologic therapies for inflammatory skin diseases (ISDs), such as psoriasis and atopic dermatitis. These biologics include tumor necrosis factor-α inhibitors, interleukin (IL)-4/IL-13 inhibitors, IL-17 inhibitors, and IL-12/IL-23 inhibitors. The precise relationship between CTCL onset and biologic exposure remains unclear, highlighting an important and evolving clinical concern. This review examines potential associations between CTCL development and commonly used biologic therapies for ISDs, with a particular emphasis on underlying immunological and molecular mechanisms. This review is intended to offer insights that can guide future research regarding molecular pathways involved in CTCL pathogenesis after biologic treatment, thus refining therapeutic strategies and improving patient care.