Skin health advice for transplant patients
Transplant patients and other immunosuppressed patients are at greater risk of a range of skin infections and also skin cancer. This section will focus on the risks to transplant patients; however, if you are a patient with a suppressed immune system due to a medication you are taking or a condition that you have, then you may wish to ask a healthcare professional about your risks.
The British Society for the Skin Care of Immunocompromised individuals (BSSCII) has produced a comprehensive Patient Information Leaflet entitled ‘Skin Care after Transplant.’ This provides an excellent overview of skin care following a transplant and includes examples of the more common types of infections, the harmless skin lesions which can develop after a transplant, as well as the different types of skin cancer.
Barts Health has also produced excellent videos for patients.
These can be accessed here:
Organ transplant patients have a much higher risk of skin cancer than the general population. Whilst all transplant patients are at risk, some are more likely than others to develop skin cancer. The major risk factors for skin cancer are:
- Having skin which burns and freckles easily in the sun. These patients often have blue, green, grey or hazel eyes and red or blonde hair.
- Patients with outdoor work and hobbies who have had a lot of sun exposure in the past
- Previous history of skin cancer or pre- cancerous skin lesions before your transplant
- Having your transplant after the age of 50
- The longer you have had your transplant the greater your risk
People of colour are less likely to develop the common types of skin cancer, however, it is important that you continue to regularly protect and check your skin. People born in Africa, the Middle East, the Mediterranean and the Caribbean are at increased risk of developing a type of skin cancer called Kaposi Sarcoma, caused by a virus called human herpes virus (HHV8), which is very common in these areas. More information about this is available in the patient information leaflet mentioned above: ‘Skin care after transplant’ and in the patient information video ‘skin problems you may experience after a transplant if you have black and minority ethnic skin’.
Understanding how to protect your skin from the sun and learning how to examine your skin to look for any changes are an important part of your ongoing skin care. Here are some online resources which you may find helpful:
- The sunscreen fact sheet
- Sun advice for skin of colour
- ABCDEasy way to check moles
- A guide to checking your skin
All patients should be offered the opportunity to be seen in a dermatology clinic for a baseline assessment and the need for ongoing skin checks will then be determined. All patients, whatever their individual risk should continue to self-examine their skin and report any concerns to their GP, transplant consultant or skin clinic so that a further assessment in the dermatology clinic can be organised, if necessary.
To learn more about skin cancer in organ transplant patients please see our Patient Information Leaflets:
- Information and Advice About Skin Cancer for Patients with an Organ Transplant
- Information and Advice on Skin Cancer for Patients Awaiting an Organ Transplant
- Know the facts about common skin cancers
- Skin cancer – general information
You should see your doctor if you have any marks on your skin which are:
- Changing in appearance in any way
- Never healing completely
Remember, if in doubt, get it checked out.
Other skin issues to be aware of
Side-effects can be experienced from the different types of immunosuppressant drugs used to help prevent rejection of the transplanted organ. These can include overgrowth of the gums and development of harmless white/yellowish bumps on the skin called sebaceous hyperplasia on ciclosporin, increased risk of acne and skin fragility on prednisolone, hair loss with tacrolimus and impaired wound healing with sirolimus. If you notice any changes to your skin once you have started immunosuppressant drug treatment, then you can discuss this with a member of your medical team and, if necessary, advice from a dermatologist can be sought.
Organ transplant patients are at greater risk of skin infections including:
Fungal infections can involve the skin when it is known as ‘ringworm’ or tinea corporis. Fungal infection in the form of athletes’ foot can cause scaling in between the toes and this can sometimes involve the nails which then become thickened and develop white/yellow colour changes.
Pityriasis means a type of fine skin scaling, and versicolor means changing colour. It is a common and harmless rash due to overgrowth of a yeast on the skin called malassezia. This is not related to yeast in food or to the yeast infection that causes thrush. It is also sometimes called tinea versicolor.
Warts are localised thickenings of the skin,.The term ‘plantar warts’ is used for those that occur on the soles of the feet (the ‘plantar’ surface) when they are also known as verrucas.
Warts are caused by infection in the outer layer of the skin (epidermis) with a virus called the ‘human papilloma virus’. There are many different strains of this virus. Infection makes the skin over-grow and thicken resulting in the growth of warts and verrucas.
Herpes Virus Infections-
Herpes viral infections include herpes simplex and herpes zoster, also known as varicella zoster.
There are two herpes simplex viruses that cause skin infection. They are called herpes simplex type 1 (typically cause cold sores) and type 2 (typically cause painful blisters in the genital area). The virus can be transferred from person-to-person by direct skin-to-skin contact. These infections can recur in all of us, but may be more of a problem after a transplant due to the immunosuppressant drug treatment. They usually appear as painful blisters or sores, commonly on the mouth, genital area, and the hands. Most people are only infected in one area and unlikely to transfer the infection to other parts of their body.
Varicella Zoster Virus
The varicella zoster virus is the virus which causes chicken pox and shingles. After a person has had chickenpox, the virus lies inactive in the nervous system. Shingles occurs when the virus reactivates, causing a painful blistering rash. The rash usually covers a well-defined area of skin on one side of the body only (right or left) and will not cross to the other side of the body. Shingles can affect any area, but the most common areas include the body or down an arm or leg. Less commonly, shingles can affect one side of the face, and occasionally can cause complications affecting one eye. Shingles is more likely to occur, and can be more serious, in transplant patients. If you think you have chickenpox or shingles, then you should speak to your GP.