Frequent diverse complications: Skin problems in organ recipients mainly re
sult from the induced immunosuppression but also from specific adverse effe
cts of immunosuppressive drugs. The degree of extension and gravity of the
clinical manifestations are often proportional to the intensity and/or dura
tion of the immunosuppressive therapy. Immunodepression mainly leads to inf
ectious and neoplastic complications.
Infections: viral and fungal infections are the most frequently encountered
. Herpes simplex and zoster infections require treatment to prevent viscera
l involvement. Human papillomavirus infections occur in 80% of patients 5 y
ears after transplantation and can lead to malignant transformation. Fungal
infections include pityriasis versicolor and often extensive dermatophytos
is.
Cancer: Increased rate of cancer occurs especially in patients with viral d
isease. Skin cancers involving papillomavirus are the most frequent cancers
observed in transplant recipients, occurring in half of the long-term surv
ivors. Squamous cell carcinoma of exposed areas are the most common; they a
re often more aggressive than in non-immunodepressed patients (multiple sit
es, recurrence). Exposure to sun is a proven inducer. There is a 500-fold h
igher 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 immunod
epression and their prognosis is improved with reduction in immunosuppressi
ve therapy. Prevention requires regular dermatology work-ups and counseling
about strict protection from sun exposure.