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

The presentation discusses systemic chemoprevention and modification of immunosuppression in managing skin diseases, particularly skin cancer in transplant recipients and immunosuppressed patients. Systemic chemoprevention involves using pharmacological or natural agents to prevent or reverse skin cancer development, targeting various mechanisms such as inflammatory cytokines and oxidative stress. The speaker reviews three main agents: nicotinamide, acetretin, and capecitabine, along with a discussion on sirolimus as a way to modify immune suppression. Nicotinamide, a form of vitamin B3, has shown promise in reducing non-melanoma skin cancers in high-risk patients, particularly those with prior histories of squamous cell carcinoma, although some trials faced recruiting challenges and were underpowered. Acitretin is a retinoid aiding keratinocyte and tumor control, with evidenced benefits in transplant recipients. Lastly, capecitabine, traditionally used for cancer treatment, has been associated with significant reductions in the incidence of squamous cell carcinomas in some case studies. Sirolimus, a macrolide, reduces skin cancer risk in organ transplant patients by inhibiting tumor cell growth but is associated with potential adverse effects like hyperlipidemia and increased infection risk. Throughout the talk, practical guidelines for administration and monitoring of these treatments are highlighted.