FREQUENT DIVERSE COMPLICATIONS: Skin problems in organ recipients mainly result from the induced immunosuppression but also from specific adverse effects of immunosuppressive drugs. The degree of extension and gravity of the clinical manifestations are often proportional to the intensity and/or duration of the immunosuppressive therapy. Immunodepression mainly leads to infectious and neoplastic complications.
Infections: Viral and fungal infections are the most frequently encountered. Herpes simplex and zoster infections require treatment to prevent visceral involvement. Human papillomavirus infections occur in 80% of patients 5 years after transplantation and can lead to malignant transformation. Fungal infections include pityriasis versicolor and often extensive dermatophytosis.
Cancer: Increased rate of cancer occurs especially in patients with viral disease. Skin cancers involving papillomavirus are the most frequent cancers observed in transplant recipients, occurring in half of the long-term survivors. Squamous cell carcinoma of exposed areas are the most common; they are often more aggressive than in non-immunodepressed patients (multiple sites, recurrence). Exposure to sun is a proven inducer. There is a 500-fold higher risk of Kaposi disease linked to HHV8 virus. This disease can regress simply after reducing the immunosuppressive treatment. Other more uncommon tumors such as lymphomas, melanomas, sarcomas and Merkel cell tumors also appear to occur at an increased rate in transplant recipients.
Prevention: Most malignant skin tumors are the expression of marked immunodepression and their prognosis is improved with reduction in immunosuppressive therapy. Prevention requires regular dermatology work-ups and counseling about strict protection from sun exposure.