The incidence of cutaneous malignancy is low among Asian liver transplant recipients, with viral warts the most common cutaneous infection occurring, according to study finding published in JAAD International.

Researchers assessed the epidemiology of dermatologic disorders in liver transplant recipients at a hospital in Singapore from January 1, 2006, to January 1, 2021. Eligible patients had a follow-up of at least 1 year and had annual skin examinations by a dermatologist.

The study authors also performed a literature search in the PubMed, MEDLINE, and Cochrane databases in March 2021 to identify original articles written in English using the keywords ‘‘liver transplant’’ and ‘‘dermatology.’’


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A total of 99 liver transplant recipients were included. The mean age at transplantation was 57.7 ± 7.2 years, 68% were men, and 83% were Chinese. The mean follow-up was 7.4 ± 4.1 years (range, 1.8-15 years).

Of the cohort, 79% of patients had a dermatologic diagnosis during follow-up. Inflammatory skin diagnoses were the most frequently occurring (53%), followed by skin infection (36%). In addition, 30% of patients had benign skin lesions and 10% had premalignant or malignant lesions.

Viral warts were the most common skin infection (14%). Other skin infections included fungal infections (8%) (tinea infection [4%], onychomycosis [3%], and pityriasis versicolor [1%), folliculitis (5%), herpes simplex infections (3%), cutaneous abscesses (2%), intertrigo (2%), erysipelas (1%), and ecthyma (1%).

A total of 4 cases (4%) of cutaneous malignancies were observed in the cohort and included basal cell carcinoma (n = 1) and Bowen disease (n = 3). The mean duration after transplant to a diagnosis of malignant/premalignant lesions was 8.1 ± 3.96 years.

In the literature review, 9 studies were included. The mean duration from liver transplant was 3 to 9 years. The incidence of cutaneous malignancy ranged from 0.8% to 48%, and the pooled cumulative incidence of cutaneous malignancy from all included studies was 2.8%.

Study limitations include the small population size from a single center. In addition, 15% of the patients were not examined by the dermatologists, and there was no pre-existing protocol for pretransplant dermatologic surveillance.

“Although the skin cancer burden in liver transplant recipients is low in Singapore (a predominantly Asian cohort), control of viral wart infections remains a key area of need,” stated the researchers. “Moving forward, a long-term dermatology follow-up should be routine for all liver transplant recipients, in view of the wide spectrum of skin conditions faced by liver transplant recipients. As shown in this study, these include skin cancers, opportunistic skin infections (warts, fungal, and bacterial infections), and inflammatory skin conditions (eczema, sebaceous hyperplasia, and acne). These conditions are best managed by dermatologists.”

Reference

Lian BS, Krishnamoorthy TL, Oh CC. Skin conditions in liver transplant recipients in a Singapore academic medical center: a retrospective cohort study. JAAD Int. 2021;4:70-78. doi:10.1016/j.jdin.2021.06.002