Skin diseases in children with organ transplants.
ABSTRACT Skin diseases are frequent in organ transplant recipients, but studies concerning children are sparse.
We assessed skin diseases in children who had received organ transplants.
A total of 145 children referred to our dermatologic consultation were studied.
Steroid-induced striae distensae and acne occurred only in adolescents; severe cyclosporine-related side effects were more frequent in younger children. The most common findings were warts (53.8%), tinea versicolor (14.5%), herpes simplex/zoster (9.6%), molluscum contagiosum (6.9%), and impetigo contagiosum and folliculitis (6.2%). Other notable disorders included a diffuse hyperpigmentation with a "dirty" appearance of the skin, pyogenic granulomas, melanocytic nevi proliferation, and skin tags. Two of 20 further adult patients who received transplants during childhood had squamous cell carcinomas.
Children who have received organ transplants frequently present side effects of immunosuppressive drugs and infectious diseases. Most disorders are related to the age of the patients rather than to the length of immunosuppression, whereas others are favored by the reinforcement of immunosuppression. Skin cancers were not encountered, but the risk of carcinomas in early adulthood should be considered.
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ABSTRACT: Introduction: Several skin disorders, immunosuppression-induced, have been described in transplant recipients. The aim of our study is to characterize the clinical spectrum of skin disorders and to compare the findings in liver and kidney transplant recipients. Material and Methods: A retrospective descriptive study was conducted. Data were collected from the medical records of all liver and kidney transplant recipients from 2000 - 2010 who had been referred to our Dermato-Venereology Department. Results: Three hundred nineteen transplant recipients (23.5%) have been seen, resulting in 410 diagnoses (230 in the subpopulation of liver transplant recipients and 180 in the subpopulation of kidney transplant recipients) grouped into 4 categories: 1) cutaneous infections; 2) skin cancer or premalignant skin lesions; 3) cutaneous side-effects; 4) non-iatrogenic skin disorders. Cutaneous infections were the most common presentations (42.2%), on average 32.7 months after transplantation. The latter group included 20.5% of fungal, 12.7% viral and 8.5% bacterial infections. Skin cancer and premalignant skin lesions made up 11.7% of all diagnoses, over a mean of 44.8 months post transplant and occurring primarily in kidney transplant recipients (20.6% vs 4.8% in liver transplantation patients; P < 0.001). The kidney transplant population had a squamous cell carcinoma (SCC) to basal cell carcinoma (BCC) ratio of 1.3:1 with SCC predominance, and the liver transplant population had a BCC:SCC ratio of 3.5:1. We also identified 10.5% of cutaneous side effects and 35.6% of non-iatrogenic skin disorders. Discussion: Although neoplastic pathology is more frequently mentioned in the literature, cutaneous infections were the most common diagnoses in our study. The significant differences between the two subpopulations studied may be related to higher immunosuppression after kidney transplantation. Conclusion: The high number of skin disorders reported in these patients makes it essential for Dermato-Venereology to be included within the multidisciplinary post-transplant care provided. (Full text: http://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/412/3775)Acta medica portuguesa 11/2013; 26(5):555-63. · 0.15 Impact Factor
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ABSTRACT: Striae distensae are an extremely common, therapeutically challenging form of dermal scarring. Risk factors have been reported but much remains to be understood about their epidemiology, diagnosis and treatment. Up-to-date knowledge of the scientific research and the evidence behind both preventative and therapeutic agents is vital in order to understand striae and to offer patients the best therapeutic alternatives. We present a clinical review of the current literature concerning striae distensae and both their prevention and treatment. A systematic review of the literature was undertaken utilising MEDLINE, EMBASE and Google scholar. Articles in English, Spanish, Portuguese, Turkish and French were included. Striae distensae occur in pregnancy, puberty and obesity as well as in numerous medical conditions and following therapeutic interventions. Aetiological mechanisms proposed relate to hormones, physical stretch and structural alterations to the integument. Assessment methods include subjective visual scoring and various imaging modalities. Treatments, which we have evaluated, include topical agents used prophylactically or therapeutically as well as light and laser therapies, which have shown improvements in the appearance of striae. No high quality, randomised controlled trials evaluating treatments for striae distensae exist. Topical therapeutic agents appear to lack efficacy in the prevention of striae distensae. This article is protected by copyright. All rights reserved.British Journal of Dermatology 10/2013; · 3.76 Impact Factor
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ABSTRACT: The increasing in the number of kidney transplant recipients has favored, more frequently than before, the emergence of dermatoses and warranted their study through subsequent publications. to evaluate the frequency of dermatoses in kidney transplant recipients. kidney transplant recipients with suspected dermatoses between March 1st 2009 and June 30th 2010. 53 patients (28 males and 25 females), aged between 22 and 69 (mean age = 45 years) were evaluated. Most of them came from the cities of Ceilândia, Samambaia and São Sebastião/DF, and had already been transplanted for 5 to 10 years before (37.7%); 62.3% were recipients of living donors and 83% were prednisone-treated. The most prevalent dermatoses were of fungal (45.3%) and viral (39.6%) etiologies. Among the non-melanoma malignant neoplasms, the basal cell carcinoma prevailed (six cases), in spite of the low incidence. Concerning fungal dermatoses, 12 cases of onychomycosis, five of pityriasis versicolor and four of pityrosporum folliculitis were reported. For diagnosis, in most cases (64.2%), laboratory examinations (mycological and histopathological) were performed. cutaneous manifestations in kidney transplant recipients are generally secondary to immunosuppression. The infectious dermatoses, especially those of fungal origin, are frequently found in kidney transplant recipients and their occurrence increases progressively according to the time elapsed from the transplantation, which makes follow-up important.Anais brasileiros de dermatologia 06/2013; 88(3).