Skin disease in immunosuppressed patients in relation to epidermal Langerhans' cells

Warts and skin tumours are common in renal transplant recipients (RTR). The increased susceptibility to skin lesions has been attributed to immunosuppressive treatments. The epidermal antigen-presenting Langerhans' cell (LC) is important for cutaneous immunosurveillance. The number of LC is reduced by UV light and by immunosuppressive therapy. One hundred and seventy-three immunosuppressed patients (RTR) were examined for signs of skin disease such as warts, premalignant or malignant skin lesions. The aim of this study was to determine whether the prevalence of these lesions varied between different immunosuppressive protocols and if there was an association between Langerhans' cell density, skin lesions and immunosuppressive therapy. Five years after transplantation, there was no difference in the prevalence of warts or dysplastic lesions in patients with triple drug therapy (cyclosporine, azathioprine and prednisolone) as compared with patients who had been treated with cyclosporine and prednisolone alone. Patients treated with azathioprine+prednisolone for 10-25 years had a higher prevalence of warts as well as dysplastic lesions. Long-term follow-up is needed to determine whether the risk of skin lesions is differently affected by different immunosuppressive therapies. LC density was assessed in 35 patients and in controls. There was a significant reduction in LC number in immunosuppressed patients, with the lowest density in patients on triple drug therapy and in patients on long-term azathioprine treatment. There was no significant difference in LC density between patients with and without skin lesions.