User login

Enter your username and password here in order to log in on the website:
Login

Forgot your password?

Please note: While some information will still be current in a year, other information may already be out of date in three months time. If you are in any doubt, please feel free to ask.

Immunosuppression / reddened skin

Question
Dear expert team,

my son had a transplant and is taking, among other things, tacrolimus (Prograf®) and mycophenolate mofetil (Cellcept®) for immunosuppression. The skin on his face and hands is turning very red very quickly in sunny weather even if he tries to protect himself (shade and SPF 30). He was advised to take beta carotene, but that does not help either.

Is the reddened skin equivalent to a sun burn? Na does this constitute an increased risk of skin cancer? What else could one do?

Many thanks in advance for your answer.

Kind regards,
Answer
Hello,

we passed on your question to Dr. Jens Gottlieb of Hannover Medical School. This is his answer:

“A lot of drugs can lead to a pathological increase in photosensitivity of the skin. Sometimes, the reactions of the skin are similar to a sun burn and its consequences. The reason for this is the drugs’ ability to absorb light particles (photons). This stimulates the active ingredients and puts them into a state of high energy for a short time. In this process, the energy released in the skin harms the cells.

Transplant patients usually take a lot of drugs, some of which can also increase photosensitivity, which leads to reddened skin. Examples of active ingredients with this effect are: itraconazole, furosemide, hydrochlorothaizid [translator’s comment: did not find a corresponding translation for this], azathioprine, nifedipine, and ACE inhibitors. Cortisone belongs to them as well, because it causes, among other things, a thinning of the epidermis, which provides light protection. Tacrolimus (Prograf®) and MMF (Cellcept®) do not belong to the classic group of light sensitizing agents.

The following recommendations are sensible for patients who have been prescribed light sensitizing drugs:

- take drugs with a brief half-life period at night
- avoid sunlight between 11 a.m. and 3 p.m.
- avoid solariums
- use textiles (clothes) for light protection
- prefer sunscreen with high UV-A protection

One has to distinguish from this the increased risk of white skin cancer (squamous epithelium tumor) caused by immunosuppressives (Tacrolimus/Prograf® and mycophenolate mofetil/Cellcept®). Prophylactic light protection is extremely important With these as well. There has been some controversy about the use of retinoids for medicinal prophylaxis of skin cancer. Retinoids are chemical substances whose chemical structure of biological activity is similar to vitamin A. Due to their numerous side effects (among others, increased photosensitivity), they are used only rarely for this purpose.

Kind regards,
Dr. Gottlieb
26.10.2009