Paradoxic eczema in infants after heart transplantation

Area of Science:

• Dermatology
• Immunology
• Transplantation

Background:

• Tumor necrosis factor inhibitors are known to cause new-onset psoriasis.
• Systemic tacrolimus is a calcineurin inhibitor used for immunosuppression post-transplant and topically for eczema.

Observation:

• Three pediatric cardiac transplant recipients developed a paradoxical eczema.
• Eczema onset occurred 2-48 months after initiating systemic tacrolimus therapy.

Findings:

• The observed eczema is analogous to drug-induced psoriasis seen with other immunosuppressants.
• Anecdotal evidence suggests that tapering tacrolimus and switching to alternative immunosuppressants may resolve the skin condition.

Implications:

• This paradoxical eczema highlights a potential adverse effect of systemic tacrolimus in transplant patients.
• Management strategies should focus on optimizing skin barrier, minimizing triggers, and careful selection of immunosuppressive regimens.
• Further research is needed to understand the mechanism and refine treatment protocols for tacrolimus-induced eczema.