Cutaneous manifestations in renal transplant recipients

Prabakaran, M (2013) Cutaneous manifestations in renal transplant recipients. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION: Renal transplantation is the treatment of choice for better quality of life in end stage renal disease patients. The long term success of renal transplantation depends largely on the prevention of allograft rejection. In renal transplant patients, a state of generalized non-specific immunosuppression has been induced to prevent the rejection of graft by using various drugs (such as corticosteroids, cyclosporine, tacrolimus, azathioprine and mycophenolate mofetil). The immunosuppress ion induced by drugs to prevent the graft rejection renders the renal transplant recipients more susceptible to bacterial, viral and fungal infections and predisposes to the various dermatosis, premalignant and malignant skin conditions which may cause significant morbidity and mortality. The consequence of immunosuppress ion differs markedly with geographic allocation, racial group and skin type. The present study is undertaken to find the prevalence and to identify spectrum of skin diseases in renal transplant recipients in our centre. AIM OF THE STUDY: 1. To study the prevalence of cutaneous diseases in Renal Transplant Recipients. 2. To study the various dermatosis in Renal Transplant Recipients. 3. To study the incidence and types of cutaneous infections in Renal Transplant Recipients. 4. To study the cutaneous side effects of immunosuppressive drugs in Renal Transplant Recipients. 5. To correlate the duration of the immunosuppressive therapy that predisposed to various dermatosis in Renal Transplant Reipients. MATERIALS AND METHODS: This study spanned a course of one year from December 2012 to November 2012. During this period, 80 renal transplant recipients on systemic immunosuppressive therapy attending the Department of Nephrology and Dermatology were screened. The detailed history of each patient was noted with reference to age and sex, symptomatology and duration of skin manifestations, dose and duration of immunosuppressive agents, date of transplantation and family history of similar lesions. The patients were examined thoroughly for all cutaneous manifestations. The duration of the cutaneous lesions, the size and extent of involvement were noted. In patients with dermatophytosis the morphology of lesion with reference to presence of inflammation, well defined or ill defined margin and central clearance were recorded. Those patients in whom the infection lasted for more than one year in spite of adequate treatment were classified as cases of chronic dermatophytosis. All the patients were subjected to routine hematologic investigations like complete haemogram, standard biochemical 40 investigations like blood sugar, blood urea, serum creatinine, serum electrolytes, calcium and phosphate levels. Detailed urine examination was carried out in all of them. Screening for HIV was also done in all the renal transplant recipients. Mycological investigations in cases of fungal infections included microscopic examination of skin scales, mucosal scraping, pus and touch smear from skin biopsy were done after adding 10% Potassium hydroxide (KOH) solution. Nail scraping material was examined under light microscopy after adding 40% KOH in suspected cases of onchyomycosis. Gram stain and Ziehl Nielson stain were done in all suspected cases of cutaneous infection. Tzanck smear was done in vesiculobullous skin lesions. In willing patients, skin biopsy was done and the specimens were stained with haemotoxylin and eosin (H&E) and in required cases special stains like Periodic-ac id Schiff (PAS) Gomori’s methenamine silver (GMS) were used to confirm the diagnosis. Appropriate treatment was given for all the renal transplant patients presented with cutaneous lesions. CONCLUSION: The prevalence of skin lesions in renal transplant recipients was found to be high. Among the screened patients, most common manifestation were fungal infections, followed by drug induced cutaneous changes, viral infections and bacterial infections. The superficial fungal infections like pityriasis versicolor, dermatophytosis and candidiasis were commonly encountered, of which pityriasis versicolor was the commonest, followed by dermatophytosis. The renal transplant recipients could be considered as a high risk group for the infection with malessezia and dermatophyte. Candidiasis was less frequently seen in kidney transplant patients. There is an increased incidence of phaeohypomycosis in renal transplant patients on prolonged immunosuppression. Herpes zoster and verruca vulgaris were the commonest viral infections seen in renal transplant patients. Among the bacterial infections, the commonest was furunculosis followed by impetigo. In drug induced cutaneous changes, cushingoid facies were commonly seen, followed by striae and acneiform eruptions. Gum9hyperplasia and hypertrichosis were commonly seen in cyclosporine containing drug regimen. The drug induced cutaneous changes w ere less common after one year of post transplantation. In the initial 6 months of post transplant period commonly observed cutaneous manifestations were candidiasis, herpeslabialis, chickenpox, furunculosis and acneiform eruptions. Pityriasis versicolor lesions w ere frequently seen during the 7 to 12 months of post transplant period. The dermatophytosis, herpes zoster and verruca vulgaris were commonly manifested between 7 to 24 months of post transplant period. The anticipation of certain cutaneous lesions in the particular phase of post transplant interval and early diagnosis and treatment will improve the quality of life in renal transplant recipients.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Cutaneous manifestations ; renal transplant recipients.
Subjects: MEDICAL > Dermatology Venereology and Leprosy
Depositing User: Punitha K
Date Deposited: 21 Jun 2018 14:22
Last Modified: 23 Jun 2018 03:07

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