Tony Chu - Skin Cancer2 - Prevention and Management of Skin...

Tony Chu
Dermatology at Imperial College,
Hammersmith Campus
Prevention and Management
of Skin Problems

Dermatology IC at Hammersmith
Skin and Renal Transplantation

Renal transplantation demands systemic
immunosuppression to prevent graft rejection

Immunosuppression has a major impact on the
skin increasing the incidence of infections, pre-
cancerous and cancerous changes in the skin

Many of the skin problems related to
immunosuppression can be reduced with
appropriate advice and management

Dermatology IC at Hammersmith
Immunosuppression and Infection

Infections are more common in the
immunosuppressed patient:

Acute bacterial - folliculitis, furunculosis, abscesses,
cellulitis, erysipelas

Chronic infection - tuberculosis

Viral infections - herpes simplex, warts

Fungal - ringworm, tinea versicolor

Most can be treated conventionally

Dermatology IC at Hammersmith
Warts and the Immunosuppressed

Warts are caused by the human papilloma virus

They are commonest in childhood but a common
nuisance at all times of life

Human papilloma virus is now implicated in the
development of cervical cancer - HPV types 16,
18, 45 and 31

parts of the viral DNA - E6 and E7 - link to specific
genes in human cells, transforming them into cancer
cells

Dermatology IC at Hammersmith
Immunosuppression, Warts and Skin
Cancer

Genetic model - Epidermodysplasia
verruciformis

Genetic immunosuppression predisposes to
infection with specific wart viruses - HPV 5 and
8

Following sun exposure, the virus leads to
transformation of skin cells into cancer cells and
the development of squamous cell carcinomas

Dermatology IC at Hammersmith
Warts in Renal Transplant Recipients

Warts tend to develop after 4 to 5 years following
transplantation

Increased in sun exposed areas

Many will contain EV warts virus or other
oncogenic viruses

Real risk of these warts developing into
squamous cell carcinomas following sun
exposure