Clinical Study of Porokeratosis Associated with Immunosuppressive Therapy in Renal Transplant Recipients
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Background: The etiology of porokeratosis (PK) remains unknown, but immunosuppression is known to be a factor in the pathogenesis of PK and it may also exacerbate PK. Objective: The aim of this study was to examine the clinical characteristics of PK associated with immunosuppressive therapy in renal transplant recipients. Methods: A total of 9 renal transplant patients diagnosed with biopsy-proven PK from January 2001 to December 2006 were enrolled. The authors analyzed the patient and medication histories, clinical characteristics, and associated diseases. Results: The ages of the 9 patients ranged from 38 to 67 years (mean 52 years). All received multi-drug regimens comprised of two or three immunosuppressive agents (steroids, cyclosporine, mycophenolate mofetil, azathioprine and/or tacrolimus). Times between transplantation and the onset of PK ranged from 2 to 9 years (mean 4.1 years). No family history of PK or a history of intense sun-exposure was elicited. The number of the lesions was less than ten in 8 of the 9. Lesions were mainly located in the extremities, though some affected the trunk or neck (3). Three patients had disseminated superficial actinic PK (DSAP), PK Mibelli, or both types. Associated diseases included verruca (4), recurrent herpes simplex (1), actinic keratosis (1), and cutaneous B cell lymphoma (1). Conclusion: The three clinical patterns of PK occurred equally in our patients, namely, coexistent PK Mibelli and DSAP, or the DSAP and Mibelli types as independent forms. Our findings support the notion that the different variants of PK be viewed as parts of a heterogeneous clinical spectrum. Further studies are needed in order to establish the clinical patterns of PK in immunosuppressed patients.
Abstract
Background: The etiology of porokeratosis (PK) remains unknown, but immunosuppression is known to be a factor in the pathogenesis of PK and it may also exacerbate PK. Objective: The aim of this study was to examine the clinical characteristics of PK associated with immunosuppressive therapy in renal transplant recipients. Methods: A total of 9 renal transplant patients diagnosed with biopsy-proven PK from January 2001 to December 2006 were enrolled. The authors analyzed the patient and medication histories, clinical characteristics, and associated diseases. Results: The ages of the 9 patients ranged from 38 to 67 years (mean 52 years). All received multi-drug regimens comprised of two or three immunosuppressive agents (steroids, cyclosporine, mycophenolate mofetil, azathioprine and/or tacrolimus). Times between transplantation and the onset of PK ranged from 2 to 9 years (mean 4.1 years). No family history of PK or a history of intense sun-exposure was elicited. The number of the lesions was less than ten in 8 of the 9. Lesions were mainly located in the extremities, though some affected the trunk or neck (3). Three patients had disseminated superficial actinic PK (DSAP), PK Mibelli, or both types. Associated diseases included verruca (4), recurrent herpes simplex (1), actinic keratosis (1), and cutaneous B cell lymphoma (1). Conclusion: The three clinical patterns of PK occurred equally in our patients, namely, coexistent PK Mibelli and DSAP, or the DSAP and Mibelli types as independent forms. Our findings support the notion that the different variants of PK be viewed as parts of a heterogeneous clinical spectrum. Further studies are needed in order to establish the clinical patterns of PK in immunosuppressed patients.
참고문헌 (23)
- Wolff-Schreiner EC, "Porokeratosis. In: Fitzpatrick's dermatology in general medicine", pp.532~537 (2003), McGraw-Hill
- Kanitakis J, "Porokeratosis and immunosuppression", Eur J Dermatol, 8, pp.459~465 (1998)
- Manganoni AM, "In ment of epidermal Langerhans cells in porokeratosis of immunosuppressed renal transplant recipients", J Am Acad Dermatol, 21, pp.799~801 (1989)
- Raychaudhuri SP, "Porokeratosis in immunosuppressed and nonimmunosuppressed patients", Int J Dermatol, 31, pp.781~782 (1992)
- Lugo-Janer G, "Prevalence and clinical spectrum of skin diseases in kidney transplant recipients", J Am Acad Dermatol, 24, pp.410~414 (1991)
- Kanitakis J, "Porokeratosis in organ transplant recipients", J Am Acad Dermatol, 44, pp.144~146 (2001)
- Cohen EB, "Cutaneous complications in renal transplant recipients", Am J Clin Pathol, 88, pp.32~37 (1987)
- Herranz P, "High incidence of porokeratosis in renal transplant recipients", Br J Dermatol, 136, pp.176~179 (1997)
- 이해웅, "심장이식 후 발생한 한공각화증 1예", 대한피부과학회지, 42(9), pp.1192~1194 (2004), 대한피부과학회
- 송지연, "신장이식 후 면역억제제 투여 중 발생한 한공각화증 1예", 대한피부과학회지, 40(2), pp.224~226 (2002), 대한피부과학회
- Cho YH, "A case of disseminated superficial porokeratosis in immunosuppressed kidney transplant recipient", Korean J Dermatol, 30, pp.539~542 (1992)
- Sontheimer RD, "Perturbation of epidermal Langerhans cells in immunosuppressed human renal allograft recipients", Transplantation, 37, pp.168~174 (1984)
- Imakado S, "Abnormal DNA ploidy in cells of the epidermis in a case of porokeratosis", Arch Dermatol, 124, pp.331~332 (1988)
- Kanatakis J, "Porokeratosis. In: Skin disease after organ transplantation", pp.183~194 (1998), John Libbery Eurotext
- Sasson M, "Porokeratosis and cutaneous malignancy. A review", Dermatol Surg, 22, pp.339~342 (1996)
- Anzai S, "Squamous cell carcinoma in a renal transplant recipient with linear porokeratosis", J Dermatol, 26, pp.244~247 (1999)
- Otsuka F, "Porokeratosis and malignant skin tumors", J Cancer Res Clin Oncol, 117, pp.55~60 (1991)
- Penn I, "Skin disorders in organ transplant recipients. External anogenital lesions", Arch Dermatol, 133, pp.221~223 (1997)
- Ferrandiz C, "Epidermal dysplasia and neoplasia in kidney transplant recipients", J Am Acad Dermatol, 33, pp.590~596 (1995)
- Silver SG, "Fatal squamous cell carcinoma arising from transplant-associated porokeratosis", J Am Acad Dermatol, 49, pp.931~933 (2003)
- Nayeemuddin FA, "Topical photodynamic therapy in disseminated superficial actinic porokeratosis", Clin Exp Dermatol, 27, pp.703~706 (2002)
- Agrawal SK, "Topical tretinoin in Indian male with zosteriform porokeratosis", Int J Dermatol, 42, pp.919~920 (2003)
- Harrison S, "Porokeratosis of Mibelli: successful treatment with topical 5% imiquimod cream", Australas J Dermatol, 44, pp.281~283 (2003)