The most common and debilitating skin problems arise from the long-term use of glucocorticoids. The manifestations include: striae, friable skin, ecchymosis, acne-form rash and cushingoid features. In addition, cyclosporine may cause thickening of the skin, hypertrichosis, gingival hyperplasia, epidermal cysts, pilar keratosis, and folliculitis. Treatment includes reducing the dosage of these medications to the lowest level necessary to maintain immunosuppression and topical measures.
Fungal infections of the skin are common among transplant recipients include: tinea, molluscum contagiosum, malassezia furfur and Candida. Treatment with topical agents is usually adequate, and systemic spread is extremely rare.
Viral warts occur in more than 50% of transplant recipients, usually in sun-exposure areas. The causative agent of warts is the Human Papilloma Virus (HPV) of which there are 18 different subtypes. Type 5 may predispose to squamous cell carcinoma of the skin. Warts and skin cancer often appear in the same patient. Genital warts (condyloma acuminata) result from sexual transmission of a Human Papilloma Virus (HPV). The lesions are often resistant to therapy with topical preparation. Further, the lesions may recur after surgical removal, fulguration, cryotherapy, or laser therapy. Both condylomata and cervical neoplasias occur with an increased incidence following transplantation and often appear together in the same patient.
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