- Email: [email protected]
Website in brief
Post-transplantation skin care Skin Diseases After Organ Transplantation Edited by Sylvie Euvrard, Jean Kanitakis, Alain Claudy. Paris: Éditions John Libbey Eurotext. 1998. Pp 244. £34/$58/FFr320. ISBN 2-7420-0241-5 he first thing that might spring to mind when when the words skin and organ transplantation are seen together is the very high frequency of benign and malignant skin
suppression that gives rise to skin problems, but immune cells transplanted with the graft that subsequently attack the host. In the skin, this attack can result in acute and chronic reactions. The chronic form resembles scleroderma; one hypothesis is that this response is an alloimmune reaction shifting towards an autoimmune event. A most puzzling aspect, which currently defies explanation, is that graft-versushost reactions can occur in patients after autologous bone-marrow transplantation. Although the cutaneous complications of solid organ graft-versus-host reactions are covered in the book. However, there is only brief mention of the possible complications of xenotransplantation. The risk of new epidemics of viral diseases after breaking another natural barrier between species is mentioned, but the editors do not take a stance on the subject. Finally, it is common knowledge that many complications in organ transplantation result from “overimmunosuppression”. The increased incidence of malignancies has helped maintain the popularity of this otherwise ill-defined term. Patients indeed receive complex schedules of multi-drug therapy. However, the editors must have been unaware of the recent interest in cyclosporin as a drug that itself changes tumour behaviour and metastasis. The benefit of introducing a new organ is accompanied by the risk of devastating another. In view of the prominent place the skin takes in complications of immunosuppression in organ transplantation, the design of immunosuppressive regimens that do not suppress the skin immune system in equal amounts would be an important step forwards in transplantation medicine.
simplex, HHV8-associated-Kaposi’s sarcoma, oral hairy leukoplakia, and opportunistic infections. But this text does not only present the practising clinician with classical descriptive dermatology. The contents also reflect a practical awareness with chapters on photoprotection (often forgotten but essential in the general management of any organ transplant recipient) and on the role of systemic and/or topical retinoid therapy in the prevention and treatment of skin malignancies. The text culminates with the editors, who are surgeons from the Edouard Herriot Hospital, Lyon, France, making the first attempt to formulate guidelines for the management of the cutaneous complications of organ t r a n s p l a n t at i o n . These guidelines include suggestions Female Face Raquel Martínez-Ruiz for changes that can Jan D Bos tumours in organ recipients. For that be made to the immunosuppressive regDepartment of Dermatology AO-235, reason, several transplantation centres imen once certain skin diseases arise. University of Amsterdam, Academisch have now started specialist clinics to A particularly interesting and chalMedisch Centrum, PO Box 22700, deal with the many dermatological lenging area is that of graft-versus host1100 DE Amsterdam, Netherlands complications of transplantation medireactions. Here, it is not immunocine. These clinics have wide-ranging tasks, since the cutaneous effects of transplantation are not limited to Formidable and timely science resource SciCentral is an easy-to-navigate metatumours. The majority of skin problems site that is a gateway to thousands of online resources grouped by science area—eg, after organ transplantation seem to be biological, health, physical and chemical, policy and ethics, earth and space, and the result of the immunosuppressive engineering. In addition, it offers an excellent array of links to sources of breaking regimens to which patients are exposed. science news, research highlights, and special reports from the websites of—among This complex dermatology of immunoothers—BBC News, New Scientist, American Physical Society, NASA, Discovery supression is admirably reflected in the Online, and the American Psychological Association. Special features include chapters gathered together by the ediresources for teaching science in schools, links to academic programmes and institutors of Skin Diseases After Organ tion locators, and a Media Room that provides selected audio/video broadcasts Transplantation. Thus, in addition to the related to science and technology. A free, weekly e-mail update service allows users h u m a n - p a p i l l o m av i ru s - a s s o c i at e d to select from over 120 topics, including a wide range of medical specialties. benign and malignant skin tumours, the Marilynn Larkin [email protected] (SciCentral http://www.scicentral.com/) text presents us with descriptions nonopportunistic infections such as herpes
T
Website in brief
THE LANCET • Vol 354 • August 28, 1999
785
suppression that gives rise to skin problems, but immune cells transplanted with the graft that subsequently attack the host. In the skin, this attack can result in acute and chronic reactions. The chronic form resembles scleroderma; one hypothesis is that this response is an alloimmune reaction shifting towards an autoimmune event. A most puzzling aspect, which currently defies explanation, is that graft-versushost reactions can occur in patients after autologous bone-marrow transplantation. Although the cutaneous complications of solid organ graft-versus-host reactions are covered in the book. However, there is only brief mention of the possible complications of xenotransplantation. The risk of new epidemics of viral diseases after breaking another natural barrier between species is mentioned, but the editors do not take a stance on the subject. Finally, it is common knowledge that many complications in organ transplantation result from “overimmunosuppression”. The increased incidence of malignancies has helped maintain the popularity of this otherwise ill-defined term. Patients indeed receive complex schedules of multi-drug therapy. However, the editors must have been unaware of the recent interest in cyclosporin as a drug that itself changes tumour behaviour and metastasis. The benefit of introducing a new organ is accompanied by the risk of devastating another. In view of the prominent place the skin takes in complications of immunosuppression in organ transplantation, the design of immunosuppressive regimens that do not suppress the skin immune system in equal amounts would be an important step forwards in transplantation medicine.
simplex, HHV8-associated-Kaposi’s sarcoma, oral hairy leukoplakia, and opportunistic infections. But this text does not only present the practising clinician with classical descriptive dermatology. The contents also reflect a practical awareness with chapters on photoprotection (often forgotten but essential in the general management of any organ transplant recipient) and on the role of systemic and/or topical retinoid therapy in the prevention and treatment of skin malignancies. The text culminates with the editors, who are surgeons from the Edouard Herriot Hospital, Lyon, France, making the first attempt to formulate guidelines for the management of the cutaneous complications of organ t r a n s p l a n t at i o n . These guidelines include suggestions Female Face Raquel Martínez-Ruiz for changes that can Jan D Bos tumours in organ recipients. For that be made to the immunosuppressive regDepartment of Dermatology AO-235, reason, several transplantation centres imen once certain skin diseases arise. University of Amsterdam, Academisch have now started specialist clinics to A particularly interesting and chalMedisch Centrum, PO Box 22700, deal with the many dermatological lenging area is that of graft-versus host1100 DE Amsterdam, Netherlands complications of transplantation medireactions. Here, it is not immunocine. These clinics have wide-ranging tasks, since the cutaneous effects of transplantation are not limited to Formidable and timely science resource SciCentral is an easy-to-navigate metatumours. The majority of skin problems site that is a gateway to thousands of online resources grouped by science area—eg, after organ transplantation seem to be biological, health, physical and chemical, policy and ethics, earth and space, and the result of the immunosuppressive engineering. In addition, it offers an excellent array of links to sources of breaking regimens to which patients are exposed. science news, research highlights, and special reports from the websites of—among This complex dermatology of immunoothers—BBC News, New Scientist, American Physical Society, NASA, Discovery supression is admirably reflected in the Online, and the American Psychological Association. Special features include chapters gathered together by the ediresources for teaching science in schools, links to academic programmes and institutors of Skin Diseases After Organ tion locators, and a Media Room that provides selected audio/video broadcasts Transplantation. Thus, in addition to the related to science and technology. A free, weekly e-mail update service allows users h u m a n - p a p i l l o m av i ru s - a s s o c i at e d to select from over 120 topics, including a wide range of medical specialties. benign and malignant skin tumours, the Marilynn Larkin [email protected] (SciCentral http://www.scicentral.com/) text presents us with descriptions nonopportunistic infections such as herpes
T
Website in brief
THE LANCET • Vol 354 • August 28, 1999
785