Systemic Chemoprevention and Modification of Immunosuppression in Skin Disease for Transplant Recipients and Immunosuppressed Patients

The presentation focuses on systemic chemoprevention and immunosuppression modification in preventing skin diseases in transplant and immunosuppressed patients. The discussion outlines three main categories in reducing skin cancer risk: topical field therapy, systemic chemoprevention, and modification of immunosuppression. Highlighted are studies showing the efficacy of acetretin, which significantly decreased squamous cell carcinoma (SCC) incidence in renal transplant patients. However, recent findings suggest mixed results for its efficacy in other immunocompromised patients. Nicotinamide's controversial effectiveness is also discussed, revealing it did not significantly reduce keratinocyte carcinomas, although invasive SCCs showed a slight decrease. Capsaicin is noted as a systemic preventive treatment, yet its side effects limit its use, despite some positive outcomes in reducing SCC rates. The presentation indicates a lack of high-quality prospective trials for modifying immunosuppression in patients with SCC, emphasizing the need for consensus among transplant nephrologists on intervention strategies. Key recommendations include discussions with dermatology after a first low-risk SCC and considering immunosuppression changes in higher risk stages. The overall aim is to optimize management strategies to enhance patient outcomes in skin disease prevention.