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Iatrogenic Immunodeficiency and Skin Disease

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Clinical and Basic Immunodermatology

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Abstract

Skin cancer in organ transplant recipients (OTR) is an ongoing problem as the number of living OTR grows due to an increasing number of transplants performed and longer patient and graft survival time. Kidney transplants, followed by liver transplants, account for the majority of cases. Chronic immunosuppression, along with other risk factors, places these patients at higher risk of developing malignancies, the most common being cutaneous malignancies. The dose and duration of immunosuppression are more important as risk factors than any one immunosuppressive agent in particular. It is thought that immunosuppressive drugs accelerate the development of skin cancer by being directly carcinogenic and by creating a state of compromised immune surveillance. Management of these patients requires a multifaceted approach involving the transplant team, dermatologists, other care providers and the patients. Treatment and follow up may then be determined on an individual basis on the patient’s risk factors and the relative risk of the skin cancer. Patients should perform monthly skin self-examinations and have their skin examined by a physician annually.

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Author information

Authors and Affiliations

  1. Department of Dermatology, Texas Tech University HSC, Lubbock, TX, USA

    Ramya Kollipara MD

  2. The University of Texas Medical School at Houston, Houston, TX, USA

    Elizabeth Shane

  3. Department of Dermatology, Texas A&M Health Science Center College of Medicine, Temple, TX, USA

    Sheevam Shah MD

  4. Department of Dermatology, University of Texas Health Science Center, Houston, 1401 Binz, Suite 200, Houston, TX, 77004, USA

    Stephen K. Tyring MD, PhD

Authors
  1. Ramya Kollipara MD
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  2. Elizabeth Shane
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  3. Sheevam Shah MD
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  4. Stephen K. Tyring MD, PhD
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Corresponding author

Correspondence to Stephen K. Tyring MD, PhD .

Editor information

Editors and Affiliations

  1. School of Medicine, University of Maryland Baltimore, Baltimore, Maryland, USA

    Anthony A. Gaspari

  2. Department of Dermatology, University of Texas Health Science Center, Houston, Texas, USA

    Stephen K. Tyring

  3. Department of Dermatology and Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA

    Daniel H. Kaplan

Questions

Questions

  1. 1.

    Which of the following risk factors for the development of non-melanoma skin cancer is most important in both the general population and organ transplant recipients?

    1. A.

      Fitzpatrick skin type

    2. B.

      Ultraviolet radiation

    3. C.

      Family history

    4. D.

      Immunosuppression

  • Answer: B

  • Explanation: Lesions tend to develop in sun-exposed areas. There is also an increased risk of non-melanoma skin cancer in OTRs reported in parts of the world with high levels of sun exposure

  1. 2.

    Which of the following immunosuppressive agents inhibits the phosphatase activity of calcineurin?

    1. A.

      Tacrolimus

    2. B.

      Sirolimus

    3. C.

      Cyclosporine

    4. D.

      Azathioprine

  • Answer: A

  • Explanation: Tacrolimus binds FK-binding protein and prevents production of IL-2 by inhibiting phosphatase activity of calcineurin. Sirolimus binds FK-binding protein-12, forming a complex that binds mTOR. Cyclosporine blocks activation of T-cells by preventing the expression of cytokine IL-2. Azathioprine blocks B and T-cell proliferation through the inhibition of purine synthesis and metabolism

  1. 3.

    Which of the following HLA subtypes increases the risk of post-transplant non-melanoma skin cancer?

    1. A.

      HLA-DR1

    2. B.

      HLA-B27

    3. C.

      HLA-DR4

    4. D.

      HLA-A11

  • Answer: D

  • Explanation: Studies have found HLA-A11 to increase post-transplant risk of non-melanoma skin cancer. This increased risk is conferred in patients with lighter, sun-sensitive skin

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Kollipara, R., Shane, E., Shah, S., Tyring, S.K. (2017). Iatrogenic Immunodeficiency and Skin Disease. In: Gaspari, A., Tyring, S., Kaplan, D. (eds) Clinical and Basic Immunodermatology. Springer, Cham. https://doi.org/10.1007/978-3-319-29785-9_39

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  • DOI: https://doi.org/10.1007/978-3-319-29785-9_39

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