Changes in facial appearance during cyclosporin treatment

Substantial changes in facial appearance developed in a group of children treated with prednisone and cyclosporin for immunosuppression after renal transplantation. In general, the children's features became coarse. There was thickening of the nares, lips, and ears, puffiness of the cheeks, prominence of the supraorbital ridges, and mandibular prognathism. The extent of the changes varied, but all eleven children followed up for more than 6 months from transplantation showed some of the changes. Patients treated with prednisone and azathioprine did not show any changes, clearly implicating cyclosporin in their aetiology. This dysmorphic syndrome along with the well-known hirsutism induced by cyclosporin may increase the risk of non-compliance with this immunosuppressive therapy.