SPECIALIST SKIN CARE FOR IMMUNOSUPRESSED PATIENTS
The The Devonshire Clinic Clinic in central London offers consultations with Dr Conal Perrett and Dr Jane McGregor, both of whom have many years’ experience treating patients who are immunosuppressed.
The people we see include:
- Organ transplant patients who have long-term treatment with immunosuppressive medications
- Patients treated with immunosuppressive medications for chronic conditions such as rheumatoid arthritis
- Patients whose immune system is not working well because they have a viral infection such as HIV
- People who are affected by a blood cancer such as chronic lymphocytic leukaemia (CLL), which can impair the immune system.
What are immunosuppressive medications and how are they used?
Anyone who has a major organ transplant, such as a heart, lung, liver or kidney transplant needs immunosuppressive medications after surgery.
These control the body’s natural immune system and reduce the risk of rejection. They need to be taken immediately after transplant surgery and some form of immunosuppression is usually needed for life.
Immunosuppressive biological medications are also used as part of the treatment for chronic diseases such as severe rheumatoid arthritis.
What effect does immunosuppression have on the skin?
If your immune system is not functioning as well as it should, your body does not have the same level of protection against infection or against rogue cells that start to show cancerous changes. In addition, some of these immunosuppressive medications can also predispose to skin cancer through other mechanisms specific to that individual medication.
This means that you are at a greater risk of developing skin cancer and a range of skin infections. Often these infections develop in unusual ways that can be easily missed unless you are seen by a specialist with experience treating immunosuppressed patients.
People with immunosuppression are at an increased risk of the following skin infections
- Fungal infection between the toes – athlete’s foot (tinea pedis), which causes itchy, scaly patches.
- Fungal nail infection –white or yellow patches develop under the nail that can lift the nail bed, causing the nail to be lost
- Fungal skin infection – commonly known as ringworm, this causes itchy, scaly red patches often on the trunk or groin
- Yeast infection of the skin – known as pityriasis versicolor, this causes pink or light brown scaly patches on the chest and back and is common in the first 24 months after a transplant
- Shingles and chickenpox – caused by the Herpes zoster virus. Chicken pox can be caught from someone else with the infection; shingles develops when immunity to the childhood infection wears off. Both are often very serious in people with immunosuppression
- Cold sores – caused by the Herpes simplex virus. In people whose immune system is being suppressed these can appear as painful blisters or ulcers on the lips, nose and buttocks
- Viral warts –lumps of hard, scaly skin on the hands or feet (a wart on the foot is known as a verruca), which develop because of infection with the human papilloma virus (HPV)
Immunosuppression also increases the risk of developing:
- Fragile skin and delayed healing – usually due to steroid treatment
- Benign lumps – including small brown seborrhoeic warts and red cherry angiomas
- Pre-cancerous skin lesions – including the dry, flaky patches known as actinic keratosis that develop on regions of the skin exposed to light, hard crusty lumps of Bowen’s disease and the raised scaly red rings of porokeratosis. All need to be monitored and/or treatment to prevent them developing into skin cancer
- Sebaceous gland hyperplasia – which causes whitish/yellowish bumps on the skin, especially the forehead
Skin cancer Patients with immunosuppression are at risk from all four major types of skin cancer:
- Basal cell carcinoma
- Squamous cell carcinoma
- Malignant melanoma
- Kaposi’s sarcoma
Specialist help from a world-renowned team
Specialist help is available at The Devonshire Clinic for immunosuppressed patients, including those who have had an organ transplant.
Dr Jane McGregor explains: “We have over twenty years special expertise in this area and can offer patients a comprehensive skin care programme, including pre and post-transplant risk assessment, skin care advice and customised follow up to reduce the risk of skin cancer and its complications.
Our team have published extensively on post-transplant skin care and are world renowned for diagnosing and treating skin cancer and infections in high risk patients.”
Contact us to discuss referrals or to make an appointment.