THE SKIN IN KIDNEY TRANSPLANT RECIPIENTS

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75-100% of KTR have some kind of cutaneous lesions represented by infections, premalignant and malignant lesions and side - effects of drugs. Moreover, new cutaneous manifestations are periodically reported. In many cases the relation cutaneous involvement - immunodeficiency is easily intuitable, but at times it may only be hypothesized.

Dermatological findings were classified as follows:

u              drug - related manifestations including both corticosteroid and cyclosporine induced changes. The first are represented by cutaneous fragility with purpuras, stellate pseudo - scars, striae distensae, acnes, facies lunaris, erytrosis, face and neck poikiloderma; the second by gum hypertrophy, hypertrichosis and cutaneous xerosis;

u             infectious pathology: a) mycosis: pityriasis versicolor, tinea, onychomycosis, candidiasis; virosis: herpes simplex, zoster and varicella; human papillomavirus infections (HPV): warts, papilloma and genital condilomata acuminata; bacterial infections: ectyma gangrenosum, streptococcal pityriasis, folliculitis and miscellaneous;

u              neoplastic pathologies: premalignancies such as actinic keratosis and leucoplakia; malignancies such as Bowen disease, basal and squamous cell carcinomas (SCC), Kaposi's sarcoma (KS); pseudomalignancies such as keratoacanthoma;

u              miscellaneous: in this group we placed lesions which were difficult to classify; some have already been reported by other Authors, others have never been described before in KTR and their relation to immunosuppression is, in our opinion, hypothetical.

The increased risk of developing cutaneous malignancies and pre-malignancies in KTR is not exclusively due to oncogenic viruses but also to the duration of immunosuppression. Azathioprine, for instance, might represent a chemical oncogenic factor inducing actinic keratosis and cutaneous carcinomas. This drug is metabolized to an active intracellular metabolite, 6-thioguanine nucleotide, which has been shown to be incorporated into DNA and unstable in the presence of ultra-violet light. The combined effect of 6-thioguanine nucleotide incorporation into DNA and sunlight provide a possible mechanism for chemical carcinogenesis of the skin. Nevertheless, new therapeutic regimes including cyclosporine do not seem to prevent development of neoplasias.

The lesions more frequently observed are represented by actinic keratosis, basal cell carcinomas and squamous cell carcinomas. There is a preponderance of squamous cell carcinomas over basal cell carcinomas which differentiate kidney transplant recipients from the general population; neoplasias occur at a younger age and metastatize more frequently compared with squamous cell carcinomas in the general population. Kaposi'sarcoma has been reported in kidney transplat recipients treated with azathioprine plus a steroid and, more frequently, with cyclosporine.

IMAGES

 PUBLICATIONS

1- Strumia R, Venturini D, Perini L, Fiocchi O. L'interferon alfa favorisce l’  involuzione del cheratocantoma nei trapiantati renali?< Atti 7° Congresso dell'Associazione Italiana di Immunofarmacologia. Stresa 14-16 novembre 1991.

2. Strumia R, Perini L, Tarroni G, Fiocchi O, Gilli P. Manifestazioni cutanee e trapianto renale. Atti Congresso Nazionale della Società Italiana di Nefrologia, Bologna 29 maggio- 3 giugno 1991.

3. Strumia R. Patologia cutanea nei trapiantati d' organo. G Ital Dermatol Venereol 1993;128:571-8.

4. Strumia R, Perini L, Fiocchi O, Soffritti S, Gilli P. Topical a-interferon in keratoacanthomas in kidney transplant recipients. Eur J Dermatol 1993;3:539-41.

5. Strumia R, Perini L, Tarroni G, Fiocchi O, Gilli P. Skin lesions in kidney transplant recipients. Nephron 1992;62:137-141.

6. Strumia R, Mantovani L, Fiocchi O, Perini L, Soffritti S, Gilli P. Reperti microbiologici nel cavo orale di trapiantati renali ed emodializzati. Il Dentista moderno 1994;7:1045-9.

7. Strumia R, Bedani PL, Lombardi AR, Perini L. Cute e rene - coinvolgimento cutaneo in pazienti con insufficienza renale cronica o in terapia dialitica sostitutiva - manifestazioni dermatologiche nei trapiantati renali. L’ Arcispedale S. Anna XLVI:345-8;1996.

8. P.L.Bedani, Strumia R. Manifestazioni cutanee nel trapiantato renale. Atti del XV Congresso Regionale, Società Italiana di Nefrologia, Caltanissetta 20-22 settembre 1996.

9. Strumia R, Bedani PL, Lombardi AR, Perini L. Manifestazioni cutanee in pazienti con insufficienza renale cronica in terapia dialitica sostitutiva. G Ital Dermatol Venereol 1997;132:321-9.

10. Strumia R, Lombardi AR, Perini L, Bedani PL. Benign nodular calcification and calciphylaxis in a haemodialysed patient. JEADV 1998;11:69-71.

11. Bedani PL, Scirè Risichella I, Strumia R, Cavazzini L, Gilli P, Calastrini C, Verzola A. Stabellini G. Kaposi’s sarcoma in renal transplant recipients: pathogenetic relation betwee the reduced density of Langerhans cells and cyclosporin-A therapy. J Nephrol 1999;12:193-196.

 12. Virgili A, Zampino MR, La Malfa V, Strumia R, Bedani PL. Prevalence of superficial dermatomycoses in 73 renal transplant recipients. Dermatology 1999;199:31-34

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