Background:Although the primary focus of transplant dermatology care is the early detection and treatment of skin cancers in an immunocompromised population, a wide variety of other important dermatologic disorders are seen. The scope and severity of these diagnoses are likely under-appreciated in the transplant community. Herein we report on the broad range of diagnoses made among a cohort of patients referred during the first year of operation of a specialized transplant dermatology clinic.

Methods:A retrospective chart review of all transplant patients referred over 1-year was performed. Patients were evaluated for all cutaneous lesions. As virtually all transplant patients had multiple dermatologic diagnoses, in each patient the condition with the highest level of acuity was designated as their primary dermatologic diagnosis. These diagnoses were then grouped into 6 broad categories: malignant lesions, pre-malignant lesions, infectious disorders, pigmentary disorders (excluding nevi and lentigines), inflammatory eruptions, and other benign diseases.

Results:A total of 100 newly referred transplant patients were evaluated of which 57 were men and 42 women (mean age 52 years). Most patients (83%) had a kidney transplant or a heart transplant (14%). Among the 100 patients there were 40 distinct dermatologic diagnoses excluding nevi and lentigines (2 malignant diagnoses, 3 pre-malignant diagnoses, and 35 benign diagnoses).

While 22% of patients had either a malignant (13%) or a pre-malignant (9%) diagnosis, 78% of patients had a benign diagnosis as their primary dermatologic diagnosis of concern. Specifically, 11% had an infectious condition, 29% had an inflammatory condition, 5% had a pigmentary disorder and 33% had “other" benign lesions. A malignant diagnoses was the most common primary dermatologic diagnoses in whites while non-malignant diagnoses predominated for other races. Five previously unrecognized benign dermatologic conditions with potential systemic involvement were diagnosed including familial mediterranean fever, erythema nodosum, porphyria cutanea tarda, sarcoidosis and alopecia areata with hypothyroidism.

Conclusions: In the course of a thorough dermatologic evaluation of transplant patients, a large number of previously undiagnosed, but important benign conditions are identified. These findings underscore the importance of specialized and comprehensive dermatologic care in the managment of transplant patients.

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