Racial Differences in Post-Transplant Skin Diseases Identified

By Marilynn Larkin

NEW YORK (Reuters Health) - Optimal post-transplant skin care for organ recipients differs by race, with blacks more prone to inflammatory and infectious conditions, researchers say.

“The risk for skin cancer has been well characterized in white organ transplant recipients (OTRs); however, most patients on the waiting list for organ transplant in the United States are nonwhite. Little is known about cutaneous disease and skin cancer risk in this OTR population,” write Dr. Christina Lee Chung of Drexel University in Philadelphia and colleagues in JAMA Dermatology, online March 8.

To investigate, the team analyzed records of 412 organ transplant recipients (about 30% white, 64% men, mean age, 60) treated from 2011 to 2016. At Drexel, these patients are routinely referred to a dermatology clinic for posttransplant evaluation.

White patients more often presented with malignancies at their first visit (67.8%); nonwhite patients more commonly had infectious (37.5%) and inflammatory (48.8%) conditions - specifically, human papillomavirus (HPV). Forty-two percent of white patients and 5.8% of nonwhites were diagnosed with skin cancer, most commonly squamous cell carcinoma.

In 79.5% of whites and 83.3% of Asians, most lesions were in sun-exposed areas of the body. Among black patients, two-thirds of lesions were in sun-protected areas - specifically, the genitals.

Fewer nonwhite patients had regular dermatologic examinations (11.4% versus 36.4%) or knew the signs of skin cancer (25.0% versus 45.4%).

The authors conclude that early treatment for nonwhite organ transplant recipients should focus on inflammatory and infectious diseases, whereas sun protection should be emphasized in white, Asian and Hispanic patients. Black patients also should be made aware of the signs of genital HPV infection.

Dr. Chung told Reuters Health, "Posttransplant dermatologic care should not be practiced with a one-size fits all mentality. The types of skin diseases affecting transplant patients may be similar between races but optimal management may be race- and ethnicity-specific.”

“It is imperative for dermatologists to thoroughly examine the groin, genital and perianal areas in the nonwhite transplant population for skin cancer, which is contrary to the traditional focus on sun-exposed areas for fair-skinned patients,” she said by email.

“Another vital piece of the puzzle,” she added, “is to recognize and address the significant disparity between white and nonwhite transplant recipients in recognizing the signs of skin cancer and going to the dermatologist for examination.”

“We need skin cancer screening protocols that are inclusive of the nonwhite transplant population,” Dr. Chung urged. “We also need to identify the relationship of high-risk human papillomavirus in the development of skin cancer in nonwhite organ transplant recipients and give serious consideration to the utility of HPV vaccination in the pre-transplant period for this patient population."

Dr. Delphine Lee, a dermatologist at Providence Saint John’s Health Center in Santa Monica, California, told Reuters Health, “This study of organ transplant recipients broadens the focus from skin cancer to infectious and inflammatory skin conditions, particularly in non-white patients.”

“Dermatologists have long been vigilant screening for skin cancer in our organ transplant recipients,” she said by email, “since we all see these patients, and the general dogma is that they are at much higher risk of developing squamous cell carcinoma - and other skin cancers - than the general population.”

“While the majority of black patients’ skin cancers were genital and half of those cancers were positive for HPV, the ethnic distribution of HPV-associated skin cancers in the general population is not always higher in black patients,” she observed.

“Ultimately, this study is valuable in that it calls our attention to other infectious and inflammatory conditions,” Dr. Lee concluded, “reminding us that our skin exams should be thorough, and definitely should include genital skin, which is often overlooked, particularly in this immune-suppressed population.”

SOURCE: https://bit.ly/2mAvxI3

JAMA Dermatol 2017.

(c) Copyright Thomson Reuters 2017. Click For Restrictions - https://about.reuters.com/fulllegal.asp

By Marilynn Larkin

NEW YORK (Reuters Health) - Optimal post-transplant skin care for organ recipients differs by race, with blacks more prone to inflammatory and infectious conditions, researchers say.

“The risk for skin cancer has been well characterized in white organ transplant recipients (OTRs); however, most patients on the waiting list for organ transplant in the United States are nonwhite. Little is known about cutaneous disease and skin cancer risk in this OTR population,” write Dr. Christina Lee Chung of Drexel University in Philadelphia and colleagues in JAMA Dermatology, online March 8.

To investigate, the team analyzed records of 412 organ transplant recipients (about 30% white, 64% men, mean age, 60) treated from 2011 to 2016. At Drexel, these patients are routinely referred to a dermatology clinic for posttransplant evaluation.

White patients more often presented with malignancies at their first visit (67.8%); nonwhite patients more commonly had infectious (37.5%) and inflammatory (48.8%) conditions - specifically, human papillomavirus (HPV). Forty-two percent of white patients and 5.8% of nonwhites were diagnosed with skin cancer, most commonly squamous cell carcinoma.

In 79.5% of whites and 83.3% of Asians, most lesions were in sun-exposed areas of the body. Among black patients, two-thirds of lesions were in sun-protected areas - specifically, the genitals.

Fewer nonwhite patients had regular dermatologic examinations (11.4% versus 36.4%) or knew the signs of skin cancer (25.0% versus 45.4%).

The authors conclude that early treatment for nonwhite organ transplant recipients should focus on inflammatory and infectious diseases, whereas sun protection should be emphasized in white, Asian and Hispanic patients. Black patients also should be made aware of the signs of genital HPV infection.

Dr. Chung told Reuters Health, "Posttransplant dermatologic care should not be practiced with a one-size fits all mentality. The types of skin diseases affecting transplant patients may be similar between races but optimal management may be race- and ethnicity-specific.”

“It is imperative for dermatologists to thoroughly examine the groin, genital and perianal areas in the nonwhite transplant population for skin cancer, which is contrary to the traditional focus on sun-exposed areas for fair-skinned patients,” she said by email.

“Another vital piece of the puzzle,” she added, “is to recognize and address the significant disparity between white and nonwhite transplant recipients in recognizing the signs of skin cancer and going to the dermatologist for examination.”

“We need skin cancer screening protocols that are inclusive of the nonwhite transplant population,” Dr. Chung urged. “We also need to identify the relationship of high-risk human papillomavirus in the development of skin cancer in nonwhite organ transplant recipients and give serious consideration to the utility of HPV vaccination in the pre-transplant period for this patient population."

Dr. Delphine Lee, a dermatologist at Providence Saint John’s Health Center in Santa Monica, California, told Reuters Health, “This study of organ transplant recipients broadens the focus from skin cancer to infectious and inflammatory skin conditions, particularly in non-white patients.”

“Dermatologists have long been vigilant screening for skin cancer in our organ transplant recipients,” she said by email, “since we all see these patients, and the general dogma is that they are at much higher risk of developing squamous cell carcinoma - and other skin cancers - than the general population.”

“While the majority of black patients’ skin cancers were genital and half of those cancers were positive for HPV, the ethnic distribution of HPV-associated skin cancers in the general population is not always higher in black patients,” she observed.

“Ultimately, this study is valuable in that it calls our attention to other infectious and inflammatory conditions,” Dr. Lee concluded, “reminding us that our skin exams should be thorough, and definitely should include genital skin, which is often overlooked, particularly in this immune-suppressed population.”

SOURCE: https://bit.ly/2mAvxI3

JAMA Dermatol 2017.

(c) Copyright Thomson Reuters 2017. Click For Restrictions - https://about.reuters.com/fulllegal.asp