Patient's Guide to Heart Transplant Surgery
Common Skin Problems Following Transplantation
The three most common skin problems following transplantation are: herpes, warts, and acne. Herpes and warts are caused by the "opportunistic" type viruses just described. Recall that immunosuppressive drugs put you at risk for developing herpes and warts because they block the ability of your immune cells to attack foreign objects. Acne is caused by Prednisone.
The virus that causes herpes is herpes virus hominis. Approximately 80% of the population has the herpes virus. It is possible for you to have the virus in your body and not have the symptoms (like skin problems) because the virus can be "dormant." When you have a herpes infection for the first time, the skin lesions look like red raised blisters on the skin and can last 2-6 weeks. Many patients develop these skin lesions again in the same area of the first lesions, but these are usually smaller, less painful, and last only 5-7 days.
When patients develop the skin lesions more than once, it is usually trauma or emotional stress that causes the dormant virus to become active.
Herpes is seen in two forms. One form, Herpes Simplex, is the common cold sore and can be treated with an antiviral cream or pills; the other form is Herpes Zoster, otherwise known as "Shingles". Most adults have been exposed to either chicken pox form or the cold sore form of herpes or even both.
Herpes zoster (shingles) is the most painful form of herpes. Herpes zoster usually occurs on the trunk or the face. The skin lesions usually form along nerve roots of the body and that is why shingles is so painful. After the skin lesions have cleared, it is unusual to have "post-herpetic pain." This type of pain is not as bad as the pain felt when you actually have the skin lesions, but the pain can last for many months.
If you develop symptoms that resemble herpes, you must report it to your transplant physician or coordinator.
Depending on the severity of the outbreak, you will either be treated with pills, creams, or intravenous infusions of medications.
Warts are infections caused by the papovirus hominis. They appear as small, rough-surfaced, skin-colored lumps on the skin. They can be slightly scaly, single, or grouped. They occur most often on the hands and fingers, but they can be found on any skin surface. Warts, like herpes, can come back more than once.
The type of treatment used for warts will depend on the size, locations, and type of wart as well as the age of the patient and the patient's desire to be treated. Liquid nitrogen is a very cold, smoky liquid that is applied to the wart to cause peeling of the skin. Another treatment involves applying salicylic acid to the wart. This will also cause the wart-infected skin to peel off. The wart can also be burned off or removed surgically.
Acne is caused when follicles in the skin become plugged with oil from the sebaceous glands. Steroids, like Prednisone, affect the skin by causing it to thicken and the sebaceous glands produce more oil. When this oil becomes trapped in the follicles, the follicles swell and produce a lump on the skin surface that becomes a "whitehead." When the whitehead continues to swell, it becomes what we call a pimple or acne.
Acne caused by Prednisone usually occurs several weeks after starting the drug. The acne caused by Prednisone is usually red, small, and all shaped the same way. It can occur anywhere on the body, but seems to occur most often on the trunk.
The most popular treatment for severe Prednisone induced acne is retinoid therapy. This is a cream applied to the skin once daily. At first, the cream will make the acne look worse by causing it to peel and look redder. The cream will not make the acne go away completely, but it will lessen its severity.
It is very important that you do not go out in the sun while you use retinoid cream, as it will cause a severe burn.
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