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SKINCARE

Skincare is very important for everyone, but particularly for renal patients who have received a transplant. Following a transplant. you will be prescribed medications to suppress your immune system. This will lower the risk of your body rejecting the new kidney. Your body's immune system is also responsible for fighting viruses and bacteria, as well as to repair damage caused by ultra-violet radiation and other harmful effects on the body. Cells that have been damaged by UV Light and viruses may eventually become abnormal. Occasionally, these abnormal cells can start to grow and become cancerous.

This information has been designed to give you details about how to look after your skin, and to reduce your risk of developing problems with skin cancer in future.

WARTS ULTRAVIOLET LIGHT (UV LIGHT) 

Although the sun gives us light and warmth, the sun also emits radiation that we cannot see, called UV light – which can cause damage to skin cells. UVA light is able to penetrate the deeper layers of skin and leads to ageing of the skin over time, as well as skin cancer. UVB light causes sunburn, and with repeated exposure, it increases the risk of skin cancer. The earth’s natural defences in the atmosphere – called the ozone layer – do filter out some of the damaging UV rays, but unfortunately, the ozone layer is being depleted over time, reducing some of this protection.

HOW DO MY DRUGS AFFECT MY SKIN?

You will be aware that the special drugs you are taking to keep your kidney working and prevent rejection are immunosuppressants reducing the effectiveness of the immune system in the skin.

The sun penetrates through the outer layer of your skin called the epidermis, and can damage the cells that are growing, causing changes in them. Part of the role of your immune system is to recognise cells that have become abnormal, and to destroy them before they cause a problem. When you are immunosuppressed, your immune system is less able to recognise and destroy abnormal cells, so there is an increased risk of skin cancer. This means that lower levels of sun exposure than usual are capable of causing skin cancers in transplant patients, compared to individuals who are not taking immunosuppressants.

This is why it is very important that all patients who are immunosuppressed should avoid exposing themselves to the sun.

SKIN INFECTIONS 

Due to the drug regime, transplant patients are also prone to certain skin infections. Skin infections are usually easily treated. It’s a good idea to keep a close eye on your skin and report any problems. If you have any concerns about changes in your skin – for example, rashes, discolouration or itching – please talk to your renal team or GP.

WARTS

Another skin ailment frequently seen in transplant patients is common warts. Warts are caused by viruses. Transplant patients are more prone to viral infections due to the immunosuppression. Some warts are very infectious and can be spread anywhere over the body just by scratching one. Warts are usually easily treated, but very rarely they can cause other problems. Please keep a look out for them and bring them to the attention of your renal team.

Sun-damaged skin

Any changes in the skin need to be carefully monitored. Solar or Actinic keratoses, or sun-spots, are conditions that may become cancerous in the future, so they are usually treated at an early stage. They are usually found on sun exposed sites such as the backs of hands, the face or scalp.

Sun-spots can remain dormant many years, but eventually they are activated by the sun: in winter they may actually seem to get better, but as soon as you go out in the summer they swell up and become more active. The larger they become, the more likely it is that they will become cancerous in future.

Sun-damaged skin is more common in transplant patients, and seen at an earlier age than the general population. This is because the normal function of the immune system is impaired by the anti-rejection medication.

As with any kind of cancer, it is highly important that they are detected and treated early. Most skin problems – including actinic keratoses and other pre-cancerous skin conditions are managed in primary care. They can often be managed using special skin creams.

CANCER

There are 3 main types of skin cancer.

The most common form seen in the general population in Britain is a basal cell carcinoma (or rodent ulcer). They are common in elderly people, but are now being seen in much younger age groups, due to sun exposure. Basal cell carcinomas are locally invasive and will grow bigger with time, but they do not spread round the body. They may appear as red or pink patches, usually with a raised, rolled edge with a central indentation.

The most common form of skin cancer in transplant patients is a squamous cell carcinoma. They usually look scaly or crusty in appearance, and may cause discomfort. If left untreated, they can spread throughout the body.

The other type of skin cancer is a melanoma. These can appear as irregular, pigmented patches on the skin. They can sometimes develop from moles you already have on your skin. It’s important to keep an eye on your moles, and report any new moles, or any changes in size, pigmentation or any itching or bleeding from a mole. Melanomas can also spread to the rest of the body.

PREVENTION IS BETTER THAN CURE

As with all illnesses, prevention is better than cure. Transplant patients should consider the following advice to protect their skin for the future.

·         Always wear a high factor sun-cream (ideally SPF 50) when going outside, taking particular care in the summer months.

·         Pay particular attention to sun-exposed areas e.g. your face, scalp, hands and the tops of your ears.

·         Be aware that your skin is still exposed to UV light even when sitting in the shade.

·         Cover your skin with clothing as much as you can – for example by wearing long sleeves and hats.

·         Be aware that having a tan does not protect your skin for UV damage

·         The use of sunbeds must be avoided

·         Consult your GP or renal team if you notice any changes in your skin.

Reviewed Jacqueline Nevols Consultant Nephrologist Wessex Kidney Centre
December 2023
Next review December 2026

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The National Kidney Federation cannot accept responsibility for information provided. The above is for guidance only. Patients are advised to seek further information from their own doctor.

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