A new study, published in JAMA Dermatology, reveals important difference in dermatologic diseases in white and non-white organ transplant recipients.
Organ transplant recipients are at high risk of acquiring cutaneous malignant neoplasms (skin cancers), primarily due to the high intensity UV radiotherapy and immunosuppression. In response, specialty dermatology clinics have been established to reduce the burden of skin cancers in organ recipients by improving skin cancer awareness and protective behaviours. Moving forward, a more comprehensive understanding of the risk factors, incidence, location, and type of skin diseases is crucial for the development of more comprehensive prevention strategies. This is particularly true for minority, non-white, populations which account for approximately 58% of the 120,000 patients that are currently on organ transplant waiting lists in the United States.
A recent retrospective review, published in JAMA Dermatology, aimed to compare the incidence of cutaneous diseases in white and non-white organ transplant recipients. The study included a total of 412 patients that were stratified based on ethnicity, resulting in 154 white patients and 258 non-white patients (including 190 blacks, 35 Asians, and 33 Hispanics). Of the included patients, 289 exhibited malignant or pre-malignant diseases, infectious processes, or inflammatory processes on the first visit to a doctor. In white patients, the incidence of malignant or pre-malignant diseases were more common than inflammatory and infectious processes. In contrast, blacks and Hispanics were most commonly diagnosed with inflammatory and infectious processes and had very few cases of malignant or pre-malignant diseases. Asians, however, had equal incidence of malignant or pre-malignant disease, inflammatory processes, and infectious processes.
Furthermore, 64 (41.6%) of the 154 white patients were diagnosed with skin cancer, whereas only 15 (5.8%) of the 258 non-white patients developed skin cancer. The authors also discovered that the location of skin lesions varied significantly between different ethnicities. Lesions developed primarily on sun exposed areas (including head, neck and scalp) in whites, partially sun exposed areas (including lower extremities and trunk) in Hispanics, and sun protected areas (including genitals) in blacks. Moreover, the time between organ transplant and diagnoses of skin cancer lesions varied significantly between the different ethnicities. Finally, despite realizing the risk of skin cancer, non-white patients were less likely to wear sunscreen or visit their doctor for a check-up.
In conclusion, the study highlights differences in post-transplant skin diseases between white and non-white patients, which can be useful in educating patients and preventing disease. For instance, treatment of non-white patients should focus primarily on inflammatory and infectious diseases, compared to whites whom are at higher risk of malignant or pre-malignant diseases. Furthermore, non-white patients should be educated more thoroughly on the risk of diseases, and should be encouraged to wear sun screen and regularly get checked for skin cancer lesions. Overall, the current study reveals crucial differences between ethnicities that can assist health care providers and clinicians in educating patients more effectively and providing more effective, more personalized, care.
Written By: Haisam Shah, BSc