By Fiona O'Reilly Zwald, MD
I was working at a kidney transplant center in Dublin, in my native Ireland, and I was on my way — I thought — to a career in internal medicine and nephrology. But as I worked with patients who had undergone drastic, yet life-saving, solid organ transplant procedures, one thing began to stand out: The toll it took on their skin.
An intense regimen of immunosuppressant drugs kept their bodies from rejecting life-giving donor organs, but it left their skin vulnerable to various infections, and even cancers. With time, I began to feel like I could almost tell which procedures patients had undergone and which medications they were taking just by looking at their skin. It was a medical history recorded in dermatological signs.
Transplant patients are subject to an increased risk of any number of skin diseases. Owing to their medically suppressed immune systems, they are vulnerable to fungal and viral infections, and can also develop pigmentation disorders and steroid-induced acne.
It is the role of the transplant dermatologist to not only treat these problems, but also monitor the patient’s overall health as revealed in the skin. Dermatological problems often result from oversuppression of the immune system, and the dermatologist may work closely with other members of the transplant team to dial in the optimum dosage of medication.
Skin cancer is a primary concern. Recipients of solid organ transplants have a skin cancer risk up to 65 times greater than those of people without transplants. The ongoing use of immunosuppressants, a history of exposure to sunlight, and a fair, easily burned skin type can be a lethal combination.
Problems tend to arise about 7 to 10 years after the transplant procedure, but skin cancers can develop even sooner. As with all cancers, timing is critical in determining outcomes. In the Atlanta metropolitan area, wait times to see a medical dermatologist can approach three to four months, an interval that could mean the difference between life and death for some patients.
With a dermatologist as an active member of the transplant team, however, a patient gains speedy access to care. The transplant dermatologist can screen the patient for skin cancer before and after the transplant procedure.
The dermatologist can also educate patients to better prepare them to mitigate risks. Patients can be