INFLAMMATORY DERMATOSES IN SOLID ORGAN TRANSPLANT RECIPIENTS

The advent of immunosuppressive medications has enabled organ transplantation between two genetically different individuals. Improved immunosuppressive regimens have resulted in a dramatic increase in the number of organ transplants worldwide, as well as increased survival rates among recipients. With the steady increase in the transplant population, multiple cutaneous complications of transplantation have been described and their recognition has become increasingly important.

Infectious and malignant changes in transplant patients are well recognized, leading to an ongoing emphasis on regular dermatological surveillance of our transplant population. Inflammatory conditions, on the other hand, are less well documented, and may be an under-recognized aspect in the dermatologic care of transplant recipients. This chapter serves to further discuss inflammatory dermatoses and their significance in transplant recipients.

Alopecia Areata (AA)

AA is generally regarded as an organ-specific autoimmune disease. This hypothesis has been supported by several findings:

1. Association with specific HLA genes

2. Perifollicular T lymphocyte and antigen-presenting cell infiltrate

3. Elevated levels of autoantibodies to follicular components

4. Increased expression of class I and class II HLA antigens in the lower follicle

5. Clinical response to immunosuppressive agents, including cyclosporine and topical tacrolimus

Given the response of AA to immunosuppressive medications, it is surprising to find reports of AA among immunosuppressed transplant recipients. A literature review reveals nine documented reports of AA occurring among transplant patients receiving cyclosporine (Table 15.1).