Each year, nearly 30,000 organ transplants are performed in the U.S., saving countless lives. However, transplantation brings risks, including cutaneous complications. On the Derm Club podcast, I had the pleasure of speaking with Dr. Jose Manuel Mascaro, a renowned dermatologist from Barcelona, who specializes in the cutaneous complications that can arise after organ transplantation. Dr. Mascaro is a consultant physician in the Dermatology Department at the Clinical Hospital of Barcelona and is a Professor of Dermatology at Barcelona University. He has contributed over 100 scientific papers and book chapters to well-known dermatologic publications and oversees the dermatology inpatient unit at the hospital clinic de Barcelona.
Dr. Mascaro emphasized that the need for dermatologic consultation varies. Younger patients with minimal sun damage may not need to consult a dermatologist for several years, while older patients should consider doing so within a year post-transplant. He also noted that skin cancer risks are significantly higher in transplant patients, with squamous cell carcinoma being the most common type. Risk factors include the patient’s age, sun exposure history, duration of immunosuppression, and the type of transplant received.
Treatment Strategies and Medication Risks
For treating multiple skin lesions, Dr. Mascaro suggests topical therapies like 5-fluorouracil or systemic treatments such as acitretin. He also indicated that melanoma, though less common in transplant patients, is particularly concerning due to their immunosuppressed state. Some medications like cyclosporine and azathioprine have been associated with higher risks of developing skin cancers.
Dr. Mascaro emphasized the importance of coordinated care between dermatologists and transplant teams. For high-risk patients or those with a history of skin issues, a referral for dermatological evaluation is highly recommended. He also underscored the necessity of patient education post-transplant. Sun protection measures, regular dermatological check-ups, and awareness of symptoms like painful lesions are crucial components of ongoing care.
Patients may also experience other types of skin issues, such as drug eruptions related to medications or bacterial and fungal infections. Treatment is often complicated by potential interactions with immunosuppressive medications. Dr. Mascaro also spoke about criteria for performing biopsies, stating that severity and persistence of symptoms could warrant such diagnostic measures.
In the larger context, Dr. Mascaro’s work is part of an ongoing research agenda to better understand the complex interplay of factors affecting skin health post-transplant. These include but are not limited to, age, sex, sun exposure history, type and duration of immunosuppression, and even the type of organ transplanted.
Managing dermatologic complications in transplant patients is a nuanced but critical aspect of post-operative care. The insights provided by Dr. Mascaro offer valuable guidance for clinicians and lay the groundwork for future research. The ultimate goal is to improve the quality of life for this vulnerable patient population while minimizing the risks associated with their long-term care. His contributions, combined with future research efforts, hold the promise of refining treatment approaches and hopefully, reducing dermatological complications in transplant patients.
