Atlas of Dermatologic Diseases in Solid Organ Transplant Recipients

Description

The number of solid organ transplant recipients is increasing worldwide every year, which has meant a significant improvement of recipient’s survival and quality of life. To prevent graft rejection, patients require long-term immunosuppression, which is responsible for their increased risk of neoplastic and infectious diseases.  This practical and concise atlas presents the most important dermatoses in solid organ transplant recipients. Providing a guide to diagnosis and appropriate therapy, it helps dermatologists, general practitioners and physicians manage the dermatoses found in organ transplant recipients.  The first three chapters discuss immunosuppressive regimens and the prevalence of dermatoses, while the other chapters approach the main diseases didactically, providing a large number of illustrations. Preface Acknowledgments Contents Part I: Immunosuppression and Iatrogeny Immunosuppression and Solid Organ Transplantation 1 Introduction 2 The Immunobiology of Rejection 3 Immunosuppressive Drugs: Mechanism of Action and Adverse Effects 3.1 Monoclonal Antibodies 3.1.1 Anti-Interleukin-2 Receptor Blockers (Fig. 2) 3.1.2 Alemtuzumab (Fig. 3) 3.2 Polyclonal Antibodies 3.2.1 Anti-Thymocyte Globulin (Fig. 3) 3.3 Calcineurin Inhibitors (Fig. 4) 3.4 Anti-Metabolites 3.4.1 Azathioprine (Fig. 5) 3.4.2 Mycophenolate (Fig. 5) 3.5 Mammalian Target of Rapamycin Inhibitors (mTORi) (Fig. 6) 3.6 Costimulation Blockers 3.6.1 Belatacept (Fig. 7) 3.7 Corticosteroids (Fig. 8) 4 Immunosuppressive Drug Regimens 4.1 Kidney 4.2 Liver 4.3 Heart 4.4 Lung 4.5 Pancreas 4.6 Multivisceral 4.7 Vascularized Composite Allotransplant 5 Risks and Benefits of the Immunosuppressive Drug Regimens References Overview of Dermatological Diseases After Transplantation 1 Overview 2 Timeline of Skin Disease 3 Pretransplant Evaluation 4 Immediate Postoperative Period 5 First Year After Transplant 6 Beyond the First Year 7 Posttransplant Infections 7.1 Viral Infection 7.2 Bacterial Infection 7.3 Mycobacterial Infection 7.4 Fungal Infection 8 Posttransplant Skin Cancer References Cutaneous Side Effects of Immunosuppressive Drugs Other Than Neoplasms 1 Introduction 2 Systemic Steroids 2.1 Epidemiology 2.2 Pathogenesis 2.3 Clinical Presentation 2.4 Histopathology 2.5 Treatment 3 Azathioprine 3.1 Epidemiology 3.2 Pathogenesis 3.3 Clinical Presentation 3.4 Histopathology 3.5 Treatment 4 Mycophenolate Mofetil 4.1 Epidemiology 4.2 Pathogenesis 4.3 Clinical Presentation 4.4 Histopathology 4.5 Treatment 5 Cyclosporine 5.1 Epidemiology 5.2 Pathogenesis 5.3 Clinical Presentation 5.4 Histopathology 5.5 Treatment 6 Tacrolimus 6.1 Epidemiology 6.2 Pathogenesis 6.3 Clinical Presentation 6.4 Histopathology 6.5 Treatment 7 mTOR Inhibitors: Sirolimus and Everolimus 7.1 Epidemiology 7.2 Pathogenesis 7.3 Clinical Presentation 7.4 Histopathology 7.5 Treatment 8 Other Immunosuppressive Agents 8.1 Monoclonal Antibodies (mAbs): Basiliximab and Daclizumab 8.2 Belatacept References Part II: Infectious Diseases Viral Diseases 1 Introduction 2 Herpes Simplex Virus (HSV) 2.1 Epidemiology 2.2 Histopathology 2.3 Clinical Manifestation 2.4 Diagnosis 2.5 Treatment 3 Trichodysplasia Spinulosa (TS) 3.1 Epidemiology 3.2 Histopathology 3.3 Clinical Manifestation (Fig. 6) 3.4 Treatment 4 Varicella-Zoster Virus (VZV) 4.1 Epidemiology 4.2 Histopathology 4.3 Clinical Manifestation 4.4 Treatment 5 Molluscum Contagiosum (MC) 5.1 Epidemiology 5.2 Histopathology 5.3 Clinical Manifestation 5.4 Diagnosis 5.5 Treatment 6 Human Papillomavirus (HPV) 6.1 Epidemiology 6.2 Histopathology 6.3 Clinical Manifestation 6.4 Treatment 7 Cytomegalovirus (CMV) 7.1 Epidemiology 7.2 Histopathology 7.3 Clinical Manifestation 7.4 Diagnosis 7.5 Treatment 8 Acquired Epidermodysplasia Verruciformis (EDV) 8.1 Epidemiology 8.2 Histopathology 8.3 Clinical Manifestation 8.4 Treatment References Bacterial Diseases 1 Introduction 2 Epidemiology 3 Pathogenesis and Clinical Presentation 4 Diagnosis 5 Treatment References Mycobacterial Diseases 1 Introduction 2 Tuberculosis 2.1 Epidemiology 2.2 Pathogenesis 2.3 Clinical Presentation 2.4 Histopathology and Laboratorial Diagnosis 2.5 Treatment 3 Leprosy 3.1 Epidemiology 3.2 Pathogenesis 3.3 Clinical Presentation 3.4 Histopathology and Laboratorial Diagnosis 3.5 Treatment 4 Non-tuberculous Mycobacteriosis 4.1 Epidemiology 4.2 Pathogenesis 4.3 Clinical Presentation 4.4 Histopathology and Laboratory Diagnosis 4.5 Treatment References Superficial Fungal Diseases 1 Introduction 2 Epidemiology 3 Pityrosporum Infections of the Skin 3.1 Concept 3.2 Etiology 3.3 Epidemiology 3.4 Pathogeny 3.5 Clinical Presentation 3.6 Diagnosis 3.7 Treatment 4 Candidiasis 4.1 Concept 4.2 Ethiopathogenesis 4.3 Epidemiology 4.4 Clinical Presentation 4.4.1 Cutaneous Candidiasis 4.4.2 Vulvo-Vaginal Candidiasis 4.4.3 Balanitis or Balanoposthitis 4.4.4 Oral and Perioral Candidiasis 4.4.5 Candida onixis and perionixis 4.5 Diagnosis 4.6 Treatment 5 Dermatophytosis or Tineas 5.1 Concept 5.2 Ethiopathogenesis 5.3 Epidemiology 5.4 Clinical Presentation 5.4.1 Tinea Capitis 5.4.2 Tinea Corporis (Tinea Circinata) 5.4.3 Tinea Cruris 5.4.4 Tinea Pedis Chronic Intertriginous Form Chronic Hyperkeratotic Form 5.4.5 Onychomycosis Distal Subungual Proximal Subungual Dermatophytic Leukonychia or Superficial White Onychomycosis 5.5 Diagnosis 5.6 Treatment 6 Other Superficial Fungal Infections 6.1 Tinea Nigra 6.2 Piedra References Deep Fungal Diseases 1 Introduction 2 Epidemiology 3 Pathogenesis 4 Diagnosis 5 Specific Deep Cutaneous Mycosis 5.1 Phaeohyphomycosis 5.1.1 Concept 5.1.2 Etiology 5.1.3 Pathogenesis 5.1.4 Clinical Presentation (Figs. 3, 4a–f, 5, 6, 7a, b, 8, 9a, b, and 10) 5.1.5 Histopathology (Fig. 11a, b) 5.1.6 Treatment 5.2 Zygomycosis 5.2.1 Concept and Etiology 5.2.2 Clinical Presentation (Figs. 12 and 13a, b) 5.2.3 Histopathology 5.2.4 Treatment 5.3 Sporotrichosis 5.3.1 Concept and Etiology 5.3.2 Epidemiology 5.3.3 Pathogenesis 5.3.4 Clinical Presentation (Figs. 14 and 15) 5.3.5 Histopathology (Fig. 16a, b) 5.3.6 Diagnosis (Fig. 17) 5.3.7 Treatment 5.4 Other Emerging Deep Fungal Mycosis (Figs. 18, 19a, b, 20a, b, and 21) 6 Systemic Mycosis 6.1 Paracoccidioidomycosis 6.1.1 Introduction 6.1.2 Epidemiology 6.1.3 Pathogenesis 6.1.4 Clinical Presentation (Fig. 22a, b) 6.1.5 Histopathology (Fig. 23a–c) 6.1.6 Diagnosis 6.1.7 Treatment 6.2 Fusariosis 6.2.1 Introduction 6.2.2 Epidemiology 6.2.3 Pathogenesis 6.2.4 Clinical Presentation (Fig. 24) 6.2.5 Histopathology (Fig. 25) 6.2.6 Diagnosis (Fig. 26) 6.2.7 Treatment 6.3 Cryptococcosis 6.3.1 Introduction 6.3.2 Epidemiology 6.3.3 Pathogenesis 6.3.4 Clinical Presentation (Figs. 27, 28, 29, 30, and 31a, b) 6.3.5 Histopathology (Fig. 32) 6.3.6 Diagnosis (Fig. 33) 6.3.7 Treatment 6.4 Histoplasmosis 6.4.1 Introduction 6.4.2 Epidemiology 6.4.3 Pathogenesis 6.4.4 Clinical Presentation (Figs. 34, 35a, b, and 36) 6.4.5 Histopathology (Fig. 37a, b) 6.4.6 Diagnosis (Fig. 38) 6.4.7 Treatment 6.5 Aspergillosis 6.5.1 Introduction 6.5.2 Epidemiology 6.5.3 Pathogenesis 6.5.4 Clinical Presentation (Fig. 39a, b) 6.5.5 Histopathology (Fig. 40) 6.5.6 Diagnosis (Fig. 41a–d) 6.5.7 Treatment References Parasitic Diseases 1 Introduction 2 Chagas Disease 2.1 Epidemiology 2.2 Pathogenesis 2.3 Clinical Presentation (Fig. 1a, b) 2.4 Histopathology (Fig. 2a, b) 2.5 Diagnosis 2.6 Treatment 2.7 Pre-transplant Screening for Chagas 3 Leishmaniasis 3.1 Epidemiology 3.2 Pathogenesis 3.3 Clinical Presentation (Figs. 3, 4, and 5) 3.4 Histopathology (Fig. 6a–c) 3.5 Diagnosis 3.6 Treatment 4 Schistosomiasis 4.1 Epidemiology 4.2 Pathogenesis 4.3 Clinical Presentation 4.4 Histopathology (Fig. 7) 4.5 Diagnosis 4.6 Treatment 5 Scabies 5.1 Epidemiology 5.2 Clinical Presentation (Figs. 8, 9, and 10) 5.3 Diagnosis (Figs. 11a, b, 12a, b, and 13a, b) 5.4 Treatment References Sexually Transmitted Infections 1 Human Papillomavirus 1.1 Epidemiology 1.2 Pathogenesis 1.3 Clinical Presentation 1.4 Histopathology 1.5 Treatment 2 Syphilis 2.1 Epidemiology 2.2 Pathogenesis 2.3 Clinical Presentation 2.4 Histopathology 2.5 Treatment 3 Molluscum Contagiosum 3.1 Epidemiology 3.2 Pathogenesis 3.3 Clinical Presentation 3.4 Histopathology 3.5 Treatment 4 Herpes Simplex 4.1 Epidemiology 4.2 Pathogenesis 4.3 Clinical Presentation 4.4 Histopathology 4.5 Treatment 5 Chancroid 5.1 Epidemiology 5.2 Pathogenesis 5.3 Clinical Presentation 5.4 Histopathology 5.5 Treatment References Part III: Neoplasic Diseases Precancerous Manifestations 1 Introduction 2 Actinic Keratosis 2.1 Pathophysiology 2.2 Epidemiology and Risk Factors 2.3 The Role of HPV Infection 2.4 Clinical Presentation 2.5 Histopathology 2.6 Detection of Actinic Keratosis in Solid Organ Transplant Recipients 2.7 Classification Systems 2.8 Differential Diagnosis 2.9 Treatment and Management of Actinic Keratosis in SOTR 3 Actinic Cheilitis 3.1 Epidemiology 3.2 Clinical Presentation 3.3 Histopathology 3.4 Differential Diagnosis 3.5 Treatment and Management 4 Bowen’s Disease 4.1 Pathophysiology 4.2 Epidemiology 4.3 Clinical Presentation 4.4 Histopathology 4.5 Differential Diagnosis 4.6 Treatment and Management 5 Penile Intraepithelial Neoplasia 5.1 Terminology 5.2 Pathophysiology 5.3 Epidemiology and Risk Factors 5.4 Clinical Presentation 5.5 Histopathology 5.6 Differential Diagnosis 5.7 Treatment and Management 6 Vulvar Intraepithelial Neoplasia 6.1 Terminology 6.2 Pathophysiology 6.3 Epidemiology and Risk Factors 6.4 Clinical Presentation 6.5 Histopathology 6.6 Differential Diagnosis 6.7 Treatment and Management 7 Anal Intraepithelial Neoplasia 7.1 Terminology 7.2 Pathophysiology 7.3 Epidemiology 7.4 Clinical Presentation 7.5 Histopathology 7.6 Differential Diagnosis 7.7 Treatment and Management 8 Keratoacanthoma 8.1 Pathophysiology 8.2 Epidemiology and Risk Factors 8.3 Clinical Presentation 8.4 Histopathology 8.5 Differential Diagnosis 8.6 Treatment and Management 9 Porokeratosis 9.1 Pathophysiology 9.2 Epidemiology 9.3 Clinical Presentation and Risk Factors 9.4 Histopathology 9.5 Differential Diagnosis 9.6 Treatment and Management 10 EV-Like Lesions 10.1 Pathophysiology and Epidemiology 10.2 Clinical Presentation 10.3 Histopathology 10.4 Treatment and Management 11 Seborrheic Keratosis, Verruca Vulgaris, and Verruca Plana 11.1 Introduction and Pathophysiology 11.2 Epidemiology 11.3 Clinical Presentation 11.4 Treatment and Management References Untitled Squamous Cell Carcinoma 1 Introduction 2 Pathogenesis and Risk Factors 3 Clinical Presentation 4 Diagnosis 4.1 Clinical Examination 4.2 Histopathology 4.3 Imaging 4.4 Staging 4.5 Metastasis Risk 5 Treatment 5.1 Systemic Treatments 6 Prevention 7 Future Perspectives References Basal Cell Carcinoma 1 Introduction 2 Epidemiology 3 Pathogenesis 4 Clinical Presentation 5 Histology 6 Treatment 6.1 Chemoprevention in SOTR 6.2 Reduction of Immunosuppression References Melanoma 1 Introduction 2 Melanoma Derived from an Organ Donor 3 A Prior Diagnosis of Malignant Melanoma in a Candidate for Organ Transplantation 4 De Novo Melanoma in an Organ Transplant Recipient 5 New Melanoma Therapies in Connection with Organ Transplantation References Kaposi Sarcoma 1 Introduction 2 Epidemiology 3 Pathogenesis 4 Diagnosis 4.1 Clinical Presentation 4.2 Histopathology 4.3 Radiology 4.4 Other HHV-8 Diagnostic Tools 5 Treatment 6 Prognosis References Lymphoproliferative Diseases 1 Introduction 2 Epidemiology 3 Pathogenesis 4 Clinical Presentation 4.1 PTLD and Skin 5 Classification 5.1 Plasmacytic Hyperplasia and Infectious Mononucleosis-Like PTLDs 5.2 Florid Follicular Hyperplasia PTLD 5.3 Polymorphic PTLD 5.4 Monomorphic PTLD 5.5 Classical Hodgkin Lymphoma-Like PTLD 6 Diagnosis and Staging 7 Treatment 7.1 Reduction of Immunosuppression 7.2 Rituximab 7.3 Chemotherapy 7.4 Surgery 7.5 Adoptive Immunotherapy 7.6 Initial Management According to PTLD Subtype (Table 5) 7.6.1 Early Lesions 7.6.2 Polymorphic PTLD 7.6.3 Monomorphic PTLD 7.6.4 Classical Hodgkin Lymphoma-Like PTLD 8 Surveillance and Prevention 8.1 EBV Viral Load 8.2 Antiviral Agents 9 Prognosis References Other Rare Cancers 1 Introduction 2 Follicular Carcinoma 2.1 Epidemiology 2.2 Pathogenesis 2.3 Clinical Presentation 2.4 Histopathology 2.5 Treatment 3 Eccrine Carcinoma 3.1 Epidemiology 3.2 Pathogenesis 3.3 Clinical Presentation 3.4 Histopathology 3.5 Treatment 4 Sebaceous Carcinoma 4.1 Epidemiology 4.2 Pathogenesis 4.3 Clinical Presentation 4.4 Histopathology 4.5 Treatment 5 Dermatofibrosarcoma Protuberans 5.1 Epidemiology 5.2 Pathogenesis 5.3 Clinical Presentation 5.4 Histopathology 5.5 Treatment 6 Angiosarcoma 6.1 Epidemiology 6.2 Pathogenesis 6.3 Clinical Presentation 6.4 Histopathology 6.5 Treatment 7 Merkel Cell Carcinoma 7.1 Epidemiology 7.2 Pathogenesis 7.3 Clinical Presentation 7.4 Histopathology 7.5 Treatment 8 Carcinosarcoma 8.1 Epidemiology 8.2 Pathogenesis 8.3 Clinical Presentation 8.4 Histopathology 8.5 Treatment References Index