Actinic Keratosis after Lung Transplant

Cutaneous complications common post-transplant

By Atul Mehta, MD

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As use of lung transplant (LT) becomes more common, pulmonologists should be aware of post-transplant dermatologic complications. In a recent pictorial review in CHEST, my colleagues and I describe the pathogenesis, epidemiological characteristics and clinical manifestations of dermatologic complications found in lung transplant recipients. Here I will focus on acitinic keratosis (AK).

AK and solid organ transplant

AK is caused by the abnormal proliferation of keratinocytes due to UV radiation. This premalignant skin lesion can potentially become squamous cell carcinoma (SCC). Classic AK appears as large, scaly, thin, erythematous papules; hypertrophic AK is thicker and sometimes manifests with cutaneous horns. Atrophic AK lacks scaling, and in pigmented AK, the scaly papules are pigmented. Actinic cheilitis and conjunctival AK are also possible.

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The patient above experienced photodamage and severe acitinic keratosis. The image below shows voriconazole-induced phototoxicity.

Because AK can transform into SCC, patients with higher risk should be screened regularly and educated about the importance and of skin surveillance and proper application of UV protection. I urge any transplant pulmonologist to incorporate counseling, treatment, education and referral to dermatology into their post-transplant visits. Early treatment for suspicious lesions is crucial, especially in this population.

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Dr. Mehta is staff in the Department of Pulmonary Medicine.

Images are republished with permission from CHEST.