Cutaneous Toxicities From Transplantation-Related Medications

The 2017 minireview addressed the non-malignant cutaneous toxicities in solid organ transplant recipients (SOTRs) caused by various medications, including antithymocyte globulins, systemic steroids, cyclosporine, tacrolimus, azathioprine, mycophenolate mofetil, mTOR inhibitors (sirolimus and everolimus), basiliximab, daclizumab, belatacept, and voriconazole. It detailed specific skin toxicities such as serum sickness, steroid acne, skin fragility, hypertrichosis, gingival overgrowth, telogen effluvium, hypersensitivity reactions, aphthous stomatitis, impaired wound healing, and pilosebaceous dermatoses. The review emphasized the importance of recognizing and managing these toxicities to reduce morbidity and mortality. Sirolimus, in particular, was associated with wound healing complications in 43.2% of patients, acneiform eruptions in 15-45% of patients, and peripheral edema in 35% of liver transplant recipients. Monoclonal antibodies had a side-effect profile similar to placebo, but severe reactions were reported. Belatacept caused peripheral edema in 35% and hirsutism in 1% of SOTRs, while voriconazole led to photosensitivity and alopecia in 8% of patients. The document concluded that identifying and managing drug-induced cutaneous manifestations is crucial for SOTR care.