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Viral Infections of the Skin

Warts:
Warts are very common in transplant recipients, and may be seen in 50-85% of the recipients 5 years after the transplantation. Warts are a non-cancerous growth in the skin. Viruses in the family of Human Papillomavirus (HPV) can cause warts. There are greater than 100 different types of HPV. Most cause the same type of appearing warty type lesions. Few of these HPV types are associated with malignant degeneration and progression into a type of skin cancer. It is most often associated with squamous cell carcinoma. Warts appear as scaly white to pink to gray bumps on the skin. When occurring on the palms of hands or soles of feet they are known for interrupting the normal skin lines. They often have black dots noted throughout them, that some refer to as the "roots"; however, these are actually thrombosed capillaries. Warts can be very difficult to treat in transplant recipients. Current therapies for warts mainly depend on the destruction of affected skin areas. This destruction can be done with chemicals such as salicylic acid, cantharidin, 5-fluorouracil, or others. Physical destruction with liquid nitrogen, laser, curettage, or excision is commonly used. Immunomodulatory creams can be used. Repetitive treatment is often required for ultimate success.

Note: Please click on the thumbnails below to display a larger image.

Common warts on hands Plantar warts on feet Flat warts on forehead

Herpes Viruses:
Herpes virus infections are important after organ transplantation, as they can be responsible for significant morbidity (poor life quality) and mortality (death) rates. The herpes viruses family includes different types of viruses such as cytomegalo-virus (CMV), herpes simplex virus (HSV), Epstein-Barr virus (EBV), and varicella-zoster virus (VZV). These all have one distinct attribute in common: After the initial infection the virus lays dormant in the nerves, and, under certain conditions, may reactivate causing symptoms. There is no available treatment that will eradicate the viruses from the human body.

Herpes simplex virus (HSV) is the cause of cold sores and genital herpes. It is not to be confused with herpes zoster (commonly known as 'shingles') or herpes varicella (commonly known as 'chickenpox'), both caused by varicella zoster virus (VZV). Other types of herpes viruses are cytomegalovirus (CMV) and Epstein-Barr virus (EBV). EBV causes kissing diseases (infectious mononucleosis), but under immunosuppression, tumors of the lymphatic system can occur as a result of this virus.

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Herpes Labialis Herpes Zoster (Shingles) Herpes Zoster (Shingles)

Nearly 40% of the organ transplant recipients develop an infection with herpes viruses after 10 years of immunosuppressive treatment. HSV and VZV are responsible for many skin infections. HSV causes mucocutaneous lesions in more that 50% of the patients within the first 5 weeks after transplantation. Within 6 months after transplantation in 15% of the patient, a herpes zoster infection (VZV) has been documented. In the early post-transplant period there may be severe, eventually life-threatening infections with these viruses.

Herpes simplex virus tends to affect those parts of the body where two different skin surfaces meet, namely the angles of the mouth, the genital area, the rectum or anus and the eye. However, in immunosuppressed patients, the virus may affect other parts of the body or may persist as chronic herpetic lesions. Reliable and early diagnosis is crucial to initiating therapy in a timely fashion so as to prevent generalized infections.

Currently, available drugs with anti-herpes virus efficacy such as acyclovir and the prodrug valacyclovir are available. These drugs are indicated for treatment of HSV and VZV. Many herpes virus infections in transplant recipients require oral or intravenous medication to adequately treat. People who experience recurrences may take continuous treatment to reduce the frequency of the recurrences. Early after transplantation, prophylaxis with antiviral medication is often done.

There are a number of other, more potent antiviral agents available. These would be prescribed under the discretion of your physician.

Molluscum Contagiosum:
Molluscum Contagiosum is a noncancerous skin growth caused by a virus infecting the top layers of the skin. It is similar to a wart, but caused by a different virus. The virus causing this skin growth belongs to the poxvirus family. The virus is spread by skin contact and enters through breaks in the skin or hair follicles. It affects only skin, not internal organs. Molluscum appears as flesh colored/pink, dome-shaped bumps on the skin, often with a central indentation. They often appear in clusters. They may affect any area of skin. In patients on immunosuppression they may become quite large. Many dermatologists recommend treating molluscum because they often spread from one skin surface area to another. In the general population molluscum can resolve on their own after six months to 5 years. In the transplant population, these growths are more persistent because of the suppressed immune system that normally rids of this viral growth. Molluscum may be treated in many different ways. Treatment with liquid nitrogen is very common. They may be treated by various other methods, including: topical creams such as a retinoid or a topical immune response modifier, blistering agents, electric needle (electrocautery), or scraped off with a sharp instrument, such a curette. Treatment is determined on an individual basis.

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Molluscum Molluscum

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Updated on Friday, June 22nd, 2012

ITSCC

October 16-19, 2014
Biennial Retreat
Essex, MA


Survey Request
We are looking at funding opportunities for a transplant skin cancer registry. A knowledge of which transplant centers are associated with our members and a rough idea of how many transplant patients are being followed would be helpful in this process. Please provide us with these brief details regarding your transplant practice. Click here to take survey