Dermatologic complications following heart transplantation

A total of 107 consecutive heart transplant recipients at Stanford University Medical Center were prospectively screened for dermatologic disease as part of their routine postoperative evaluation over a 6-month period. The incidence of nonmelanotic skin tumors and premalignant lesions was approximately 25-fold greater than expected in a normal population. Skin infections were seen in 55% of the patients and dermatologic drug side effects were almost universal including xerosis, hypertrichosis, and steroid acne. Successful excision or cryotherapy of all neoplastic lesions was achieved with no evidence of recurrence to date, a mean of 11 months. The skin infections responded to appropriate antiviral, antibacterial, and antifungal agents and the xerotic and acneiform lesions were successfully treated with emollients and topical retinoic acid, respectively. In addition, patients were instructed in preventive measures including the use of sunscreen agents and protective clothing. We conclude that heart transplant recipients have a significantly increased incidence of neoplastic, infectious, and drug-induced skin diseases. Routine dermatologic screening resulted in early identification and successful treatment of these lesions. We suggest that dermatologic screening is both feasible and valuable in this setting.